Use this form to update the GIC on the information included on your personalized benefit statements, mailed in January. Failure to notify the GIC of family status changes, such as legal separation, divorce and remarriage particularly, can be very costly to you, and you may be responsible for additional premiums or medical claims.
If you notice any errors on your benefit statement, fill out the Benefit Statement Change Form and send with the required documents, as applicable, to the GIC.
Benefit Statement Change Form 1 – for active state employees
Benefit Statement Change Form 2 – for state retirees
Benefit Statement Change Form 3 – for GIC Retired Municipal Teachers (RMTs)
Benefit Statement Change Form 4 - for municipal enrollee, state survivors and members on COBRA
This information provided by the Group Insurance Commission .
People also viewed...
You recently viewed...
Personalization is OFF. Your personal browsing history at Mass.gov is not visible because your personalization is turned off. To view your history, turn your personalization on.
Learn more on our .
*Recommendations are based on site visitor traffic patterns and are not endorsements of that content.