In compliance with the Health Care Reform Act, this form must be distributed to every employee in your agency who is not enrolled in Group Insurance Commission (GIC) health benefits or does not elect Health Connector Plan coverage. All employees who appear on Document Direct report HMBEN021 must complete a HIRD form by July 1 of each year.
The Payroll or GIC Coordinator completes Section I of the form for each employee not enrolled in GIC health benefits or Health Connector Plan coverage, distributing the form to these employees for completion. HIRD forms must be retained at the agency for three years and be made available to the Division of Health Care Finance and Policy or the Department of Revenue upon request.
HIRD Form Instructions:
For GIC-eligible employees, the Payroll Department or GIC Coordinator must fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the current rate chart. The lowest cost plan and the rates will change each year.
HIRD form, Employee section:
Question 1 refers to an employee being offered health insurance through the Group Insurance Commission. A GIC eligible employee will answer yes to this question. A non-GIC eligible employee will answer no. A GIC eligible employee will either answer yes or no to Question 1a.
Question 2 refers to both GIC eligible and non-GIC eligible employees being offered a Section 125 pre-tax deduction for their health insurance only - not the actual health benefits. A Section 125 plan allows for income reduction by providing a pre-tax benefit to pay for health insurance. The Commonwealth has two separate Section 125 plans, but both allow an employee to pay for health insurance on a pre-tax basis.
Employees must return the form to their Payroll Department or GIC Coordinator. Do not return the form to the GIC or the Health Connector. You must retain these forms for three years and make them available to the Division of Health Care Finance and Policy or the Department of Revenue upon request. We suggest that you keep all HIRD forms in a single file in alphabetical order for ease of look up.
If an employee refuses to return the form to you, you must document your efforts to obtain it.
HIRD Form Ongoing Process:
- New Hires: Add the HIRD form to your New Hire package. Every time you hire a new employee who is GIC-eligible and does not take GIC health insurance, or is not GIC-eligible and does not elect Health Connector coverage, you must complete the top section of the HIRD form and have the employee complete Section II and return it to you for filing within 30 days.
- Withdrawal from coverage: If you have an employee who drops GIC or Health Connector health insurance (e.g., obtains health insurance elsewhere, does not pay the health premiums, or goes on a military leave), you must give the employee a HIRD form to complete and return to you within 30 days.
- Annual Enrollment: Employees who do not elect coverage during the GIC's annual enrollment or the Connector open enrollment must complete a HIRD form by July 1 of each year.
120 Day Appointments
Although retirees do not complete HIRD forms, retirees who have 120 day appointments must also complete a HIRD form. Note that Question 2 should always be answered "no" for the 120 day appointments who are retired.
This information provided by the Group Insurance Commission.
