|
|
|
|
|
|
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. |
|
|
|
|
|
Plan Administrator
Ironworkers Local 97 Plan Administrator
c/o 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: Health
|
|
|
|
|
|
|
