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 are a retiree and you and your covered dependents are not covered by Medicare. - For municipal enrollees joining July 1, 2015.
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 July 1, 2015.
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 July 1, 2015.
Dependent Ages 19 to 26 Enrollment/Change Form- 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.
Municipal Retiree Dental Form - Town of Ashland Retirees and Survivors only - use this form to Enroll in the GIC Retirees Dental Plan Effective July 1, 2015.
CHIP Notice - This notice provides information on how to access premium assistance if you or your children are eligible for Medicaid or CHIP.
Marketplace notice - This notice provides some basic information concerning your current health insurance coverage and the availability of other coverage.
This information provided by the Group Insurance Commission .
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