Return all initial enrollment forms, along with required documentation, to your benefits office - Do not send to the GIC.
Required Documentation - a list of the documents you must provide, along with your enrollment application, to join the GIC.
Initial Enrollment Form for Medicare Retirees and Survivors - Use this form if you and your covered dependents are covered by Medicare.
Initial Over/Under Age 65 Medicare/Non-Medicare Combination Coverage form - Use this form if one or more family members are on Medicare and the rest are not.
Initial Enrollment Form for Non-Medicare Retirees/Survivors - Use this form if you and your covered dependents are not covered by Medicare.
Dependent Ages 19 to 26 Enrollment Application - If you wish to cover your dependent age 19 and over, complete and return this form along with the appropriate enrollment form and your dependent's birth certificate. Please note: the address on the form is the GIC's; initial municipal enrollment forms should be returned to your benefits office, not the GIC.
Handicapped Dependent Application - to cover a handicapped dependent
Retiree Dental Enrollment Form - to enroll in the GIC Retiree Dental Plan
Optional Life form and life insurance beneficiary form - only available through the GIC Coordinator in your benefits office.
- 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 your municipality's Section 125
This information provided by the Group Insurance Commission.