• Hand filling out a form.
  • Insurance Enrollment/Change and Spouse/Dependent Forms

    For State employees and Non-Medicare retirees and survivors enrolling in, changing coverage and/or canceling coverage.
  • Optional Life Insurance Open Enrollment Form

    Use this form from April 9 - June 13 to enroll in Optional Life Coverage effective October 1, 2014.
  • Dependent Ages 19 to 26 Enrollment Application

    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.
  • Buy-Out for State Employees and Retirees

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

    Form to enroll in the GIC Dental coverage.

  • Health Care Spending Account (HCSA) Forms

    Enrollment and change and claim forms for the state employee Health Care Spending Account pre-tax program.
  • Dependent Care Assistance Program (DCAP) Forms

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

    This notice, provided to all new hires, provides some basic information concerning your current health insurance coverage and the availability of other coverage.

  • Premium Assistance Notice

    This notice provides information on how to access premium assistance if you or your children are eligible for Medicaid or CHIP.

  • Required Documentation

    A list of the documents you must provide, along with your enrollment application, to join the GIC, to add a spouse or dependent, or when you are retired and you or your covered spouse become Medicare eligible. 

  • Employee Acknowledgement Form

    New hires must complete this form to verify that they have been notified about there benefit options.

  • Benefit Statement Change Form

    Use this form to notify the GIC of family status changes.
  • Handicapped Dependent Form

    Form to cover a dependent who became mentally or physically incapable of earning his/her own living prior to age 19; or became permanently and totally disabled and became so on or after age 19 and is under age 26.

  • Leaving State Service Forms

    Forms to complete when leaving state service.

  • COBRA Forms

    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.
  • COBRA Notice

  • Life Insurance Beneficiary Forms

    These forms are used to designate your beneficiary or beneficiaries in the event of your death.
  • Pre-Tax Application

    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.
  • Leave of Absence Form

    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.
  • HIPAA Privacy Forms