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MSP Application for Group Enrolment Form |
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Use
If you are covered for the Medical Services Plan of BC (MSP)
under your Health Benefit Plan, use the MSP Application for Group Enrolment Form
to enrol in the Plan.
If you are changing your group MSP coverage, you should use the
MSP
Group Change Form instead of this form. |
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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,
- Detailed information on your dependents,
- 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.
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Notes
Questions on completing the form should be directed to the Plan Administrator.
Completed forms should be forwarded to the Plan Administrator.
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Plan Administrator
D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email
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PDF
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