MSP Application

MSP Application for Group Enrolment Form


Use the MSP Application for Group Enrolment Form if you wish to be covered for the Medical Services Plan of BC (MSP) through the Ironworkers Local 97 Health & Welfare Plan.

If you are changing your group MSP coverage, you should use the MSP Group Change Form instead of this form.

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 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.


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

Completed forms should be forwarded to the Plan Administrator.