If the employee is changing from individual to family coverage, follow the below procedures:

The employee must complete and sign the following:

For Health Insurance:

  • GIC Insurance Enrollment and Change Form (Form-1).
  • Insurance Data Form (IDF)
      • For spousal coverage – copy of marriage certificate.
      • For former spouse – provide following sections of the legal separation or divorce decree: page with absolute date, health insurance language, signature pages, and former spouse’s address.
      • For dependent coverage under age 19 – copy of birth certificate(s) – the birth certificate must show the parent-child relationship to the insured or his/her spouse
      • For dependent coverage age 19 to 26 – Dependent Age 19 to 26 Enrollment and Change Form and a copy of birth certificate.

For Beneficiary:

  • Beneficiary Designation Form (Form 319) (one to three beneficiaries) or Nomination of Beneficiary Form G-500 (four or more beneficiaries or special designations such as estate and trusts)

For Dental/Vision:

Dental and Vision Enrollment and Change (Form-1) - See Dental/Vision Eligibility section for eligibility details.  If family coverage is not elected for health insurance, but the employee wishes to have family dental/vision coverage, he/she must also submit a copy of a marriage certificate to cover a spouse and birth certificates to cover dependent children and a student verification form to cover a student dependent.

For All Changes:

  1. Verify that the forms above are completed accurately and completely.  Ensure that both you and the employee have signed and dated all forms.
  2. Enter the change in the GIC MAGIC System.
  3. Photocopy completed GIC forms and file them in the employee’s personnel file.
  4. Send original signed forms to the GIC.

This information provided by the Group Insurance Commission.