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 - For municipal enrollees joining July 1, 2013.
Initial Municipality Enrollment Form for Medicare Retirees and Survivors - For municipal enrollees joining July 1, 2013.
Initial Over/Under Age 65 Medicare/Non-Medicare Combination Coverage form - for municipal enrollees joining July 1, 2013.
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.
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 Plan.
This information provided by the Group Insurance Commission.