Active State Employee Forms

For State employees and Non-Medicare retirees and survivors enrolling in, changing coverage and/or canceling coverage.

You may apply for coverage for your dependent ages 19 to 26 as a new employee, when he/she turns age 19, during the GIC's Annual Enrollment period, or with proof of loss of other health insurance coverage.

Enrollment and change and claim forms for the state employee Health Care Spending Account pre-tax program.

Enrollment, change and claim forms for the state employee Dependent Care Assistance (DCAP) pre-tax program.

If you have access to non-GIC Health Insurance (for example, through your spouse) it may pay to participate in the Buyout Program.

Form to apply for handicapped dependent coverage.

The GIC mails all enrollees a benefit statement at the end of January. It is important to report family status changes to the GIC.

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.

The Commonwealth deducts the state employee's share of basic life and health insurance premiums on a pre-tax basis, unless an employee opts out of this option.

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.

for GIC-eligible employees who do not elect GIC coverage and for non-GIC eligible employees who do not elect to pay for health insurance through a Commonwealth, offline agency or municipality-sponsored Section 125 Plan