Use this form to add your dependent ages 19 to 26 as a new employee, during the GIC’s Annual Enrollment, or with proof of loss of other health coverage. When your dependent changes to a full-time student living outside of the plan's service area or is no longer a full-time student.
Please keep in mind the following:
- The insured must have family plan coverage.
- The GIC will determine eligibility and effective dates.
You MUST notify the GIC when your dependent age 19 to 26 is no longer a full-time student or has moved out of the health plan’s service area.
This information provided by the Group Insurance Commission .