Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada

Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada

What Is Form HLTH 102?

Form HLTH 102, Medical Services Plan (MSP) Application for Enrolment, is a document that can be used by individuals who want to enter the Medical Service Plan (MSP). The MSP is a health insurance program that provides its members with health care benefits, that can cover the services of physicians and other health care practitioners.

Alternate Name:

  • MSP Application Form.

The application was issued by the British Columbia Ministry of Health and was last revised on . A fillable MSP Application is available for download below.

ADVERTISEMENT

MSP Application Form Instructions

The MSP Application Form can only be used by residents of British Columbia. Completing the document is a straightforward process, however, if the individual is completing it for the first time it might cause difficulties. Form HLTH 102 is presented on four pages, which consist of two pages of guidelines and the form itself. The document contains several parts, which include the following:

  1. Information About the Applicant. In the first part of the document, the individual can state their full name, date of birth, telephone number, residential address, and mailing address (if it is different from their residential address).
  2. Residence and Citizenship. Here, the individual is supposed to designate their status in Canada, whether they had the MSP coverage before, if they have lived in British Columbia since they were born, and answer other questions connected with their occupation and trips.
  3. Spouse and Child Information. Individuals can use this part to provide information about their spouses and children (if applicable). It should include their spouse's and child's full name, date of birth, status in Canada, where they are from, etc.
  4. Supplementary Benefits. This section of the application provides the individual with information about how benefits work. It also states that the requirements and information about eligibility can be found on the official website of the government of British Columbia.
  5. Authorization. By signing this part of the document, the individual agrees to comply with the terms and rules of the MSP, authorizes the British Columbia Ministry of Health to collect their information, and declares that everything stated in the form is true and correct. If the document contains information about the individual's spouse, they are supposed to sign this part of the form as well.
  6. Important Information. In the last section of the document, the individual can find important statements related to the address change, name change, additional documents that must be attached to the form, and other important statements.

Download Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada

4.4 of 5 (5 votes)
  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada

    1

  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 2

    2

  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 3

    3

  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 4

    4

  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 1
  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 2
  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 3
  • Medical Services Plan (Msp) Application for Enrolment - British Columbia, Canada, Page 4
Prev 1 2 3 4 Next
ADVERTISEMENT

Related Documents