Return all initial enrollment forms, along with required documentation, to your municipal benefits office.
Required Documentation - a list of the documents you must provide, along with your enrollment application, to join the GIC.
Initial Enrollment Form for Active Employees and Non-Medicare Retirees/Survivors Use this form if you are an active employee or if you and your covered dependents are not covered by Medicare. - For municipal enrollees joining January 1, 2014.
Initial Municipality Enrollment Form for Medicare Retirees and Survivors Use this form if you and your covered dependents are covered by Medicare. - For municipal enrollees joining January 1, 2014.
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. - For municipal enrollees joining January 1, 2014.
Dependent Ages 19 to 26 Application If you wish to cover your dependent ages 19 to 26, complete and return this form along with the appropriate enrollment form and your dependent's birth certificate. Note: as outlined on the form, you must notify the GIC if your dependent's status changes after completion of this form. 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.
- 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 Plan.
This information provided by the Group Insurance Commission.