Msp170 form 2026

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The document is a Medical Services Plan (MSP) Group Change Request form for residents of British Columbia, Canada. It outlines the requirements for residents to enroll themselves and their family members in the MSP, including procedures for changing account holder information, addresses, and details regarding spouses and children. The form requires legal documentation for any changes and emphasizes the importance of providing accurate information to determine eligibility for provincial health care benefits.

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Click ‘Get Form’ to open the msp170 form in the editor.
Begin by completing Section 1, marking all applicable boxes for your change request. This includes changes to account holder information, address, spouse, or child details.
In Section 2, provide the account holder's legal last name, first name, personal health number (PHN), birthdate, and gender. Ensure all information is accurate.
If you are changing your address, fill out Section 3 with the new residential and mailing addresses.
Section 4 requires your signature for authorization. Read the declaration carefully before signing.
For spouse or child changes, complete Sections 7 and 8 as necessary. Include any required legal documents as specified.
Finally, review all sections for completeness and accuracy before submitting the form to your Group Administrator for authorization in Section 5.

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