Use this form to update the GIC on the information included on your personalized benefit statements, mailed in January. Failure to notify the GIC of family status changes, such as legal separation, divorce, remarriage, and /or addition of dependents can result in financial liability to you.
If you notice any errors on your benefit statement, fill out the Benefit Statement Change Form and send with the required documents, as applicable, to the GIC.
Benefit Statement Change Form 1 
– for state employees and retirees
Benefit Statement Change Form 2
– for GIC Retired Municipal Teachers (RMTs), State Survivors and COBRA enrollees
Benefit Statement Change Form 3
– for municipal employees, retirees and COBRA enrollees
This information provided by the Group Insurance Commission.
