Active State Employee Forms
Ongoing Enrollment and Change Forms for Active State Employees
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For state enrollees, housing authority and planning council enrollees enrolling in, changing coverage and/or canceling coverage.
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Coverage for an unmarried dependent ends at the end of the month in which the dependent turns age 19 unless the Dependent Age 19 and Over Application for Coverage is completed and returned to the GIC.
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The GIC mails all state enrollees a benefit statement at the end of January. It is important to report family status changes to the GIC.
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If you are an employee of the Commonwealth of Massachusetts, you have the right to choose COBRA coverage if you lose your group health coverage because your hours of employment are reduced or your employment ends for reasons other than gross misconduct.
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Buy-Out Application - If you were insured with the GIC on January 1, 2010 or before and continue your coverage through June 30, 2010, you may buy out your health plan coverage during annual enrollment.
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Employees who are taking an approved leave of absence without pay due to one of the following three conditions (Industrial Accident, Employee's personal illness, or Maternity), may apply to continue part-cost premiums by completing this form.
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