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

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
        
   
 
 
 
   
 
 
 
 
 
   
 

Enrolment Card and Beneficiary Designation

Use
Complete the Health & Welfare Plan Enrolment Card to enrol in the Ironworkers Local 97 Health & Welfare Plan, enrol your dependents and assign your beneficiary(s).

Once a Member is enrolled in the Plan, all changes to Member information, dependents or beneficiaries should be made by completing this form in full and submitting it to the Plan Administrator.


Information Needed to Complete the Form
Your personal Member information is needed to complete the form, including the dates of birth for all eligible dependents, and the policy number of any other group insurance plans that you or your dependents may also be covered under. Please follow the instructions on the form and ensure that you have completed the card in full. You may select a revocable beneficiary of your choice for your Life Insurance benefits.



Notes
You must also fill in the Enrolment Card for the Local 97 Pension Plan to enrol in the Ironworkers Local 97 Pension Plan.

If you list a common law spouse as a dependent, you must complete the Common Law Spouse Declaration Form.

If you are covered for MSP through this plan, you must complete a separate MSP Application For Group Enrolment Form or MSP Group Change Form to update your MSP coverage.

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

Completed forms should be forwarded to the Plan Administrator.



 

Form Link
Health & Welfare Enrolment Card and Beneficiary Designation
 

Related Links
Health & Welfare Plan Booklet
Pension Plan Booklet
 
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