Forms for Group Plan Administrators
Last updated on December 15, 2023
- Group Plan Registration Forms
- Group Plan Administration Forms
- Group Plan Cancellation Forms
- Supplies Order Forms
Group Plan Registration Form
This form can be used to set up your group plan
| Form # | Form Name and Information |
|---|---|
|
201 |
Register your company to begin administering a group plan. |
Group Plan Administration Forms
These forms can be used to administer your group plan
| Form # | Form Name and Information |
|---|---|
|
167 |
Add individuals to your group plan. |
|
170 |
Report changes, including individuals' information updates, the addition or deletion of dependents, and group plan information updates. |
|
1904 |
Notify group plan members who are being removed from the group plan about their status change and what they need to do to ensure continued MSP coverage. |
Group Plan Cancellation Forms
This form can be used to request termination of your group plan with MSP.
| Form # | Form Name and Information |
|---|---|
|
295 |
Request MSP group plan termination |
This form can be used to cancel group coverage for an employee/ pensioner and all dependants.
| Form # | Form Name and Information |
|---|---|
|
217 |
Cancel group coverage for an employee, pensioner and all dependants |
Supplies Order Form
This form can be used to order paper copies of MSP brochures and forms.
| Form # | Form Name and Information |
|---|---|
|
173 |
Order paper copies of MSP brochures and forms. |