D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
        
   
 
 
 
   
 
 
 
 
 
   
 

MSP Group Change Form

Use
Use the MSP Group Change Form if you are covered for the Medical Services Plan of BC (MSP) through the Ironworkers Local 97 Health & Welfare Plan and you wish to add or delete a dependent from your MSP coverage.


Information Needed to Complete the Form
In addition to the Member's personal information, additional information is required to complete the form, including:

  • Group number (4823381), which is pre-printed on the form,
  • Detailed information on any changes to your dependents (if applicable),
  • Change in Member information (if applicable),
  • Residency information,
  • Signatures from both the Member's and spouse.
Additional information to complete the form is listed on the second page of the form. Please follow the instructions on the form.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded to the Plan Administrator.


 

Form Link
MSP Group Change Form
 

Related Links
Basic Medical Benefit Information
 
 
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