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Health Benefit Forms

As a Member of the International Association of Heat and Frost Insulators & Allied Workers, Local No. 118 Health and Wellness Trust Fund, the Plan Administrator requires certain information from you in order to provide your health coverage and ensure that any claims that you may submit are processed correctly.

Enrolment

Enrolment Card
As a new Member to the Plan, please complete the Enrolment Card and Beneficiary Designation form to provide the Plan Administrator with the full information regarding yourself, your selected beneficiary and all dependents that you wish to cover under the Health & Wellness Plan.

MSP Application
You must complete the MSP Application for Group Enrolment form if you wish to be covered for MSP under the Health & Wellness Plan.

Changes

If you are an existing Member of the Plan, you must notify the Plan Administrator immediately if your personal information, dependent information or beneficiary has changed in order to ensure that coverage is continued and claims are assessed properly.

Change Card
If your personal information, dependent information or beneficiary has changed, please complete the Enrolment Card and Beneficiary Designation form in full to notify the Plan Administrator.

MSP Change
You should complete the MSP Group Change Form if you are covered for MSP under the Health & Wellness Plan and you want to add or delete a dependent.