Updated July 29, 2014

BASIC LIFE AND HEALTH INSURANCE

An employee must provide you with proof of loss of health coverage elsewhere to be eligible to enroll in GIC basic life and health coverage at any time during the year, other than during Annual Enrollment.  An employee may not apply for late enrollment during their new hire waiting period.  Examples of acceptable proof of loss of other coverage include:

  • Letter from health insurance carrier on company letterhead, or
  • Letter from other employer on company or organization letterhead.

To add GIC basic life and health coverage during the year, include a copy of the proof of loss of coverage with the forms sent to the GIC.  You will not be able to enter information into the MAGIC system.  The GIC will determine the eligibility and effective date and will enter this information upon receipt of the required forms and proof of loss of coverage.

Basic Life and Health late enrollment procedure:

  1. Employee must complete the following forms completely and legibly:
      • Insurance Enrollment and Change Form (Form-1)
      • Insurance Data Form (IDF) for family coverage.  Must also provide:
        • 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 or over – Dependent Age 19 to 26 Enrollment form and a copy of birth certificate or, for handicapped dependent coverage – Handicapped Dependent Application and a copy of birth certificate.  Birth certificates must show the parent-child relationship to the insured or his/her spouse.
      • Beneficiary Designation Form (Form 319 or G-500)
  2. Verify that the forms are completed accurately and completely. Ensure that the employee has checked the information entered on his/her forms, and has signed and dated all forms.
  3. On the Insurance Enrollment and Change Form (Form-1), be sure to indicate the agency/division number, date of hire and salary.
  4. Photocopy completed GIC forms and copy of proof of involuntary loss of coverage and file them in the employee’s personnel file. 
  5. Send the original signed forms to the GIC along with the proof of involuntary loss of coverage.
  6. If the GIC approves the late enrollment, we will update the MAGIC system.

Optional Life

For employees enrolling in Optional Life Insurance after their original eligibility (within ten days of hire) or changing from non-automatic to automatic increase or increasing multiple factor when there is a non-qualifying family status change are subject to proof of good health satisfactory to the life insurance carrier.  To apply for coverage:

  1. Instruct the employee to complete and sign Insurance Enrollment and Change Form (Form-1).  If the employee wishes to change his/her beneficiary(ies) the employee must also complete Form 319 (one to three beneficiaries) or Form G-500 (four or more beneficiaries).
  2. Review forms for completeness.
  3. Photocopy forms and file in employee’s personnel file.
  4. Send original Insurance Enrollment and Change Form (Form-1) and Beneficiary Form to the GIC.
  5. The GIC will notify the life insurance carrier, which will send the employee a Medical Evidence of Insurability Application. If the employee does not return the medical evidence of insurability, their file will be closed. 
  6. If approved, the GIC will advise you and the employee of the effective date.
  7. If approved, the GIC will update the GIC’s MAGIC System for premium deductions.

Optional Life—Family Status Change

Employees enrolling in Optional Life Insurance after their original eligibility (within ten days of hire) have an opportunity to enroll without proof of good health when there is a qualifying family status change.  Active employees have the option of enrolling in or increasing coverage in Optional Life Insurance up to four times salary as long as the GIC receives documentation within 31 days of the event: marriage, birth/adoption, legal separation, divorce or death of spouse.  Forms and documentation received after the 31-day window will be denied.

  1. Instruct the employee to complete and sign Insurance Enrollment and Change Form (Form-1) and provide proof of qualified family status change: marriage certificate, birth certificate, adoption placement letter, legal separation/ divorce agreement, or death certificate of spouse.  If the employee wishes to change his/her beneficiary(ies) the employee must also complete Form 319 (one to three beneficiaries) or Form G-500 (four or more beneficiaries).
  2. Review forms for completeness.
  3. Photocopy forms and proof of family status change and file in employee’s personnel file.
  4. Send original Insurance Enrollment and Change Form (Form-1), proof of family status change, and Beneficiary Form to the GIC within 31 days of the qualifying event.
  5. If approved, the GIC will advise you and the employee of the effective date.
  6. The GIC will update the MAGIC System for premium deductions.

Long Term Disability

Employees enrolling in Long Term Disability after their original eligibility (within 10 days of hire) are subject to proof of good health satisfactory to the LTD carrier.  To apply for coverage:

  1. Employee must complete and sign the GIC's Enrollment and Change Form (Form-1).
  2. Sign the GIC's Enrollment and Change Form (Form-1) and review for completeness.
  3. Copy Insurance Enrollment and Change Form (Form-1) and file in the employee's personnel file.
  4. Send original Insurance Enrollment and Change Form (Form-1) to the GIC.
  5. The GIC will notify the LTD carrier of the pending application.
  6. The LTD carrier will send the employee a medical application to complete and return. If the employee does not return the evidence of insurability, their file will be closed.
  7. If approved, the GIC will notify you and the employee of the effective date.
  8. The GIC will update the MAGIC System for premium deductions.

GIC Dental/Vision

An employee must provide you with proof of involuntary loss of dental care coverage elsewhere to be eligible to enroll in GIC dental care coverage at any time during the year, other than during Annual Enrollment.  Examples of acceptable proof of loss of other coverage include:

  • Letter from dental insurance carrier on company letterhead, or
  • Letter from other employer on company or organization letterhead.

An employee may not apply for late enrollment during the 60-day new hire waiting period.

To add GIC Dental/Vision during the year with proof of involuntary loss of coverage elsewhere, you must include a copy of the proof of loss of coverage with the forms sent to the GIC.  You will not be able to enter information into the MAGIC system.  The GIC will determine the effective date of coverage and will update the GIC’s MAGIC system with the premium deduction.

To add GIC Dental/Vision coverage during the year with proof of loss of coverage:

  1. Employees must complete the GIC Dental and Vision Enrollment and Change Form (Form-1).
  2. For family coverage, employees must also submit a copy of a marriage certificate to cover a spouse and birth certificates to cover dependent children if these are not already on file for GIC health coverage. Birth certificates must show the parent-child relationship to the insured or his/her spouse.
  3. Review for completeness and be sure to indicate the agency/division number and date of hire on  the Dental and Vision Enrollment and Change Form (Form-1).
  4. Photocopy the GIC Dental and Vision Enrollment and Change Form (Form-1) and file in the employee’s personnel file.
  5. Send the original GIC Dental and Vision Enrollment and Change Form (Form-1), the proof of loss of coverage elsewhere, and a copy of the marriage certificate/birth certificate (if applicable) to the GIC.
  6. The GIC will determine eligibility and the effective date and will update the GIC’s MAGIC system with the premium deduction.

FLEXIBLE SPENDING ACCOUNTS (FSA)

Employees may during the year enroll in HCSA/DCAP, change their contribution, or terminate their election if there is a change in status according to IRS guidelines listed below. Change of election due to a status change must be made within 30 days of the qualifying event. If you are unsure whether an event qualifies as an IRS-qualified event, contact the FSA carrier:

  • Change in legal marital status.
  • Change in number of dependents.
  • Change in employee’s or spouse’s employment status (for example, employee hours increase making him or her eligible for the program, or spouse loses employment affecting enrollment in another FSA program.
  • Change in work schedule which changes eligibility for the program.
  • Dependent satisfies or ceases to satisfy eligibility requirements.
  • Judgment, decree or order pertaining to child or spouse.

Please note that the qualifying event must correspond with the change in election (i.e. marriage constitutes an increase in election; divorce constitutes a decrease in election).

To add or change the contribution to HCSA and/or DCAP during the year due to a qualifying event:

  1. Instruct the employee to complete, sign and date the HCSA/DCAP GIC Flexible Benefit Plan Change in Status Form. See the direct deposit instructions on the form.
  2. Complete the Payroll Coordinator section of the form. Indicate your Agency/Division number (ABC/1000).
  3. Obtain from the employee a document establishing a change in status.
  4. Acceptable proof includes a marriage or birth certificate or a letter from an employer stating that coverage has been terminated.
  5. Enter the HCSA/DCAP and pre-tax fee amount deductions into HR/CMS or UMASS payroll system. For instructions see the HR/CMS job aid for general deductions or contact the HR/CMS help desk.
  6. Fax a copy of the completed and signed form to the FSA carrier. Note: Failure to send a form to the FSA carrier will result in an employee not receiving reimbursement for an eligible HCSA and/or DCAP expense.
  7. File a copy of the application in the employee’s personnel file. Do not send forms to the GIC.

This information provided by the Group Insurance Commission .