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  pdf format of Initial Enrollment Form for Active Employees 
– use this form if you are an active employee and are from a municipality joining the GIC July 1, 2016.

Initial Enrollment Form for Retirees and Survivors  pdf format of Initial Enrollment Form for Retirees and Survivors 
– use this form if you are a retiree or survivor and are from a municipality joining the GIC July 1, 2016.

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 pdf format of retiree_dental_municipal.pdf
- use this form to Enroll in the GIC Retiree Dental Plan Effective July 1, 2016.

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 .