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.

If you are the spouse of an insured covered by the GIC's health benefits program, you have the right to choose COBRA coverage for yourself if you lose GIC health coverage for any of the following reasons (known as "qualifying events"): Your spouse dies; your spouse's employment with the Commonwealth or participating municipality ends for any reason other than gross misconduct or his/her hours of employment are reduced; or you and your spouse divorce or legally separate.

If you have dependent children who are covered by the GIC's health benefits program, each child has the right to elect COBRA coverage if he or she loses GIC health coverage for any of the following reasons (known as "qualifying events"): the parent dies; the employee-parent's employment is terminated (for reasons other than gross misconduct) or the parent's hours of employment are reduced; the parents legally separate or divorce; or the dependent ceases to be a dependent child under GIC eligibility rules.  

FY15 COBRA Notice, Rate and Application doc format of cobraappfy15.doc
 - for terminations before May 1, 2015

FY16 COBRA Notice, Rate and Application doc format of cobraappfy16.doc
- for terminations on or after May 1, 2015

 COBRA General Notice doc format of cobrageneralnoticefy15.doc
- GIC enrollees receive this notice in their health plan handbook to advise them of their rights under COBRA upon employment termination or family status changes.

FY15 Dental/Vision COBRA Application doc format of dentalvisioncobrafy15.doc
- (for Managers, Legislators, Legislative Staff and Certain Executive Office Staff) - for terminations before May 1, 2015

FY16 Dental/Vision COBRA Application doc format of FY16 dentalvisioncobra.doc
- (for Managers, Legislators, Legislative Staff and Certain Executive Office Staff) - for terminations on or after May 1, 2015

HCSA COBRA form doc format of COBRA_HCSA_Notice_App.doc
- HCSA enrollees may elect to contribute to the HCSA  account under COBRA by making direct payments on an after tax basis.


This information provided by the Group Insurance Commission .

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