Updated May 1, 2015

New employees must make their benefit elections within ten (10) calendar days of the employee’s first days of employment.  You, as the GIC Coordinator, have 21 days to forward forms to the GIC.  To select their benefits, employees must complete the following forms completely and legibly:

  • Enrollment/Change Form (Form-1)
    • 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/Change 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.
  • Life Insurance Beneficiary Form-319 (one to three beneficiaries) or Life Insurance Beneficiary form G-500 (four or more beneficiaries or special designations such as estate and trust).
  • Employee Acknowledgement Form
  • Marketplace Notice
  • Premium Assistance Notice (CHIP)
  • GIC Dental/Vision Enrollment/Change Form (Form-1DV) if eligible and elected.  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.  See eligibility rules in the DENTAL/VISION ELIGIBILITY section.
  • Flexible Spending Account Plan Enrollment Form

NOTE:  Advise the new employee that if he/she does not elect Optional Life insurance coverage when first eligible or does not elect the maximum amount available, he/she may apply at any time thereafter, but will be required to provide Evidence of Insurability satisfactory to the life insurance carrier unless the employee has qualifying family status change event (see  LATE ENROLLMENT section for details).

NOTE:  Advise the new employee that if he/she does not elect Long Term Disability coverage when first eligible, he/she may apply at any time thereafter, but will be required to provide Evidence of Insurability satisfactory to the LTD carrier (see LATE ENROLLMENT section  for details).

All new employees are automatically enrolled in pre-tax health insurance deductions unless they opt out of participating. This is known as a Section 125 Plan. If the employee elects to opt out, he/she must complete the Pre-Tax Basic Life and Health Insurance Plan Election Not to Participate Form.

After plan elections are made, complete the following:

  1. 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.
  2. On the Enrollment/Change Form (Form-1), indicate the agency/division number, the HR/CMS employee ID, and the bargaining unit (if applicable), date entered state service and the employee’s annual salary and effective date.  Salary is defined as the salary earned in the employment of the agency but not including any overtime pay, travel reimbursement or travel expenses.
  3. The GIC’s interface with HR/CMS and UMASS will automatically create a new employee record in the GIC’s MAGIC system within 24-48 hours after an agency hires a new employee in the HR/CMS or UMASS payroll systems
  4. Once the record is created, enter all insurance elections into the MAGIC system.  If HCSA and/or DCAP is selected, enter the HCSA/DCAP and pre-tax fee amount deductions into HR/CMS or UMass payroll system.
  5. Photocopy completed GIC forms and file the copies in the employee’s personnel file. 
  6. Give the employee a copy of the Employee Acknowledgement form and file the original Employee Acknowledgement form, and Pre-Tax Basic Life and Health Insurance Plan Form (if applicable) in the employee’s personnel file.  Send the Flexible Spending Account Plan Enrollment 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.  Do not send any of these forms (Employee Acknowledgement, Pre-Tax or HCSA/DCAP) to the GIC.
  7. Send all other original signed forms to the GIC.

If declining health or all GIC benefits:

  1. Employee completes and signs the Enrollment/Change Form (Form-1), checking the decline health only or decline all GIC coverage box.  This form is necessary to document that the employee was offered GIC health coverage in accordance with IRS requirements.
  2. Retain completed Enrollment/Change Form (Form-1) and file in the employee’s personnel file.  Do not send the form to the GIC.


If a new employee, or his/her covered dependent has no health coverage and incurs unplanned and urgent medical expenses during his/her new hire waiting period, he/she may apply to buy GIC health coverage at the full cost premium for that period of time (60 or more days, depending on the date of hire).  The total claims expenditure must exceed the full cost premium for the hiatus period.  New employees who begin employment on the 16th day of a month or later will not be charged premium for that month; new employees who begin employment on or before the 15th day of a month shall be charged the full premium cost for the month.  To apply for retroactive health insurance, the employee must write to the GIC’s Director of Operations to request the coverage.  If approved, coverage shall become effective as of the employee’s first day of active employment, subject to his or her timely payment of the full cost health insurance premium for the entire hiatus period.

    1.) Provide to the employee a copy of his/her new hire Enrollment/Change Form (Form-1).

    2.) Instruct the employee to include the following information in his/her request to the GIC:

    • Employee’s name
    • Employee’s Social Security Number
    • Photocopy of new hire Enrollment/Change Form (Form-1)
    • Dates of health care expenses
    • Photocopies of all incurred health care claims
    • Statement from the employee that he/she understands that he/she is responsible to pay the full cost premium for the entire new hire hiatus period

    3.) The GIC will notify the employee of the approval or denial of the application and, if approved, will bill the employee for the full cost premium owed.

This information provided by the Group Insurance Commission .

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