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 pdf format of initialmuninonmedicare.pdf 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 July 1, 2014.

Initial Municipality Enrollment Form for Medicare Retirees and Survivors pdf format of initialmunimedicare.pdf Use this form if you and your covered dependents are covered by Medicare. - For municipal enrollees joining July 1, 2014.

Initial Over/Under Age 65 Medicare/Non-Medicare Combination Coverage form doc format of Over Underenrollment Muni Form Use this form if one or more family members are on Medicare and the rest are not.  - For municipal enrollees joining July 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.

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 .