Return all initial enrollment forms, along with required documentation, to your benefits office - Do not send to the GIC.

Required Documentation doc format of Required_Documents_for_GIC_Coverage.doc
- 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 pdf format of initialMBTAmedicare.pdf
- Use this form if you and your covered dependents are covered by Medicare.

Initial Over/Under Age 65 Medicare/Non-Medicare Combination Coverage form doc format of Over Underenrollment Entities 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 pdf format of initialnonmedtransp.pdf
- Use this form if you and your covered dependents are not covered by Medicare.

Dependent Ages 19 to 26 Enrollment Application doc format of Dependent Ages 19 to 26 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.

HIRD 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 your municipality's Section 125


This information provided by the Group Insurance Commission .