Medical Services Plan (MSP) Forms


For faster, easier submission, several forms can now be submitted online and are listed in the Online Submission Forms section. Most forms are also available in PDF format to be filled out, printed and mailed to Health Insurance BC. Those that cannot be submitted online are in the Fill, Print and Mail Forms section.

Each form has a specific audience, which can include BC residents and/or Group Administrators.

Online Submission Forms: or Fill, Print and Mail Forms:
Application for Group Enrolment   Application for Group Enrolment
Group Change Request   Group Change Request
MSP Account Change   MSP Account Change
Continued Enrolment in MSP for Ages 19-24   Baby Enrolment/Addition of a Newborn
Address Change for Persons Moving Within BC   Application for Enrolment
Permanent Move Outside BC   Address Change Notice
    Application for Regular Premium Assistance
    Application for Temporary Premium Assistance
    Authorization to Release Medical Records
    First Nations Enrolment Application
    First Nations Change Request
    Group Order Form
    Out-of-Country Claim Form
    Reimbursement Request
    New Company Information (Third Party Registration)
    Coverage Cancellation
    Notice to Terminating Employees
    Schedule A: Medical Travel Insurance Assignment of Payment
    Schedule B: Authorization to Provide Medical Information
     

 


Online Submission Forms:

Listed in alphabetical order

HLTH# Form Title
7062 Address Change for Persons Moving Within BC
To change the address on your MSP plan when you are moving from one residence within BC to another residence within BC.
167 Application for Group Enrolment
To apply for enrolment under a group plan administered by your employer, pension plan, union, etc. (If you need to apply for a self-administered plan see Application for Enrolment (PDF 587K) under Fill, Print and Mail Forms.)
MPMB09 Continued Enrolment in MSP for Ages 19-24
To continue coverage for a person 19 to 24 years of age under their parent/legal guardian’s MSP account while they are attending an educational institution.
170 Group Change Request
To report changes, including addition or deletion of a family member, if you are enrolled under a group plan. For addition of a newborn, see Baby Enrolment/Addition of a Newborn.
203 MSP Account Change
To report changes, including addition or deletion of a family member, if you are enrolled under a self-administered plan. For addition of a newborn, see Baby Enrolment/Addition of a Newborn.
7063 Permanent Move Outside BC
To change the address on your MSP plan and cancel your coverage when you are moving outside BC.

Fill, Print and Mail Forms:

Listed in alphabetical order

HLTH# Form Title
6759 Address Change Notice (PDF 198K)
To change the address on your MSP plan.
More information
102 Application for Enrolment (PDF 587K)
To apply for MSP coverage under a self-administered plan.
More information
167 Application for Group Enrolment(PDF 592K)
(for Group Administrators)
To apply for enrolment under a group plan administered by your employer, pension plan, union, etc.
More information
119 Application for Regular Premium Assistance (PDF 322K)
To apply for regular premium assistance.
More information
FIN 107 Application for Temporary Premium Assistance
To apply for temporary premium assistance (administered by Ministry of Finance).
2942 Authorization to Release Medical Records (PDF 533K)
(for clients, client representatives, legal representatives or third party requestors)
To request a client’s medical records.
  Baby Enrolment/Addition of a Newborn
To enrol a newborn under MSP coverage. If a newborn is a BC resident, he/she must be enrolled under MSP.
217 Coverage Cancellation (PDF 126K)
(for Group Administrators)
To cancel an entire group-administered account (for account holder and any dependents). If you are only cancelling dependents, please use the Group Change Request (PDF 567K)
More information
178 First Nations Enrolment Application (PDF 584K)
To apply for MSP coverage if you are a registered Status Indian who is assisted by the First Nations Health Authority. The application must be authorized by the First Nations Health Authority office.
More information
308 First Nations Change Request (PDF 579K)
To report changes, including addition or deletion of a family member, if you are a registered Status Indian who is enrolled under the group plan administered by the First Nations Health Authority. The Change Request form must be authorized by the First Nations Health Authority office. For addition of a newborn, see Baby Enrolment/Addition of a Newborn.
More information
170 Group Change Request (PDF 567K)
To report changes, including addition or deletion of a family member, if you are enrolled under a group plan. For addition of a newborn, see Baby Enrolment/Addition of a Newborn.
More information
173 Group Order Form (PDF 242K)
Group Administrators – use this form to order supplies of MSP forms and pamphlets.
203 MSP Account Change (PDF 570K)
To report changes, including addition or deletion of a family member, if you are enrolled under a self-administered plan. For addition of a newborn, see Baby Enrolment/Addition of a Newborn.
More information
201 New Company Information (Third Party Registration) (PDF 164K)
(for employers, pension plans, unions, etc.)
Employers can administer MSP benefits on behalf of their employees. The application form includes information about the plan.
1904 Notice to Terminating Employees (PDF  65K)
(for Group Administrators)
To notify terminating employees that their group coverage will be ending and that self-administered coverage will begin.
More information
2814 Out-of-Country Claim Form (PDF 617K)
To submit a claim for eligible charges in other provinces and outside of Canada.
More information
2944 Reimbursement Request (PDF 527K)
To reimburse a patient only in specific circumstances for medically required services within BC that are a benefit of the Medical Services Plan.
2806 Schedule A: Medical Travel Insurance Assignment of Payment (PDF 497K)
(for private insurance company)
To allow the private insurance company to claim the provincial reimbursement for eligible out-of-country medical services.
More information
2807 Schedule B: Authorization to Provide Medical Information (PDF 495K)
(for private insurance company)
To allow the private medical travel insurance company to request detailed medical records from MSP.
More information


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