Update April 13, 2015
All GIC-eligible employees must be given a Children's Health Insurance Program (CHIP) Notice each Annual Enrollment to let them know about how to access premium assistance if they or their children are eligible for Medicaid or CHIP.
If an employee is not currently enrolled in GIC coverage and wants to do so, complete the following and send to the GIC during the Annual Enrollment period.
HEALTH INSURANCE ENROLLMENT
If an employee is not currently enrolled in GIC health insurance coverage, complete the following to enroll during Annual Enrollment:
- To select their health benefits, employees must complete the following forms completely and legibly.
- Municipal Enrollment/Change Form (Form-1MUN)
- 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. For a Handicapped Dependent, a Handicapped Dependent Application. The accompanying birth certificate(s) must show the parent-child relationship to the insured or his/her spouse.
- Municipal Enrollment/Change Form (Form-1MUN)
- Verify that the form above is completed accurately and completely. Ensure that the employee has checked the information entered on his/her forms, and has signed and dated all forms. Be sure to indicate the date of hire and agency/division number.
- Update your payroll system with the new premium deduction.
- Photocopy completed GIC form and file it in the employee’s personnel file.
- Send all other original signed forms to the GIC by the Annual Enrollment deadline.
The employee should be automatically enrolled in pre-tax health insurance deductions unless he/she opts out of participating. This is known as a Section 125 Plan.
HEALTH INSURANCE CHANGES
During Annual Enrollment, employees may change their health plan election, change from individual to family, family to individual, or remove dependent(s) from family plan. The change will go into effect that July 1.
For employees already in a GIC plan who wish to make any of these changes during Annual Enrollment:
- Employee completes and signs Municipal Enrollment/Change Form (Form-1MUN).
- Verify that the form is completed accurately and completely. Ensure that you and the employee have signed and dated all forms.
- Enter the new health plan premium deduction or coverage change into your payroll system.
- Photocopy completed GIC form and file in the employee’s personnel file.
- Send original signed form to the GIC by Annual Enrollment deadline.
NOTE: The GIC may not be able to remove a dependent if there is a court order on file at the GIC requiring the employee to cover the dependent.
PRE-TAX HEALTH INSURANCE PREMIUMS
During Annual Enrollment, or anytime during the year due to a family status change, employees may elect to opt in or out of pre-tax premium deductions. Qualifying family status changes include: marriage, legal separation, divorce, birth or adoption of a child, death of a spouse or dependent, spouse commences or is terminated from employment, employee or spouse takes unpaid leave of absence, or employee loses health insurance elsewhere through no fault of the employee.
Opt-in: Employees who elected NOT to participate in the pre-tax program may elect to participate. There are no GIC enrollment/change forms to be completed to enroll in the pre-tax program. The employee must see his/her payroll department and inform them of his/her decision to have his/her deductions made on a pre-tax basis. The payroll person updates the payroll system to reflect the employee’s pre-tax change election.
Opt-out: Employees who participate in the pre-tax program may elect NOT to participate.
- The employee completes and signs the Pre-Tax Health Insurance Election Not to Participate form.
- Forward the form to your agency’s payroll department. The payroll person updates the payroll system to reflect the employee’s pre-tax change election.
- File the original form in the employee’s personnel file. Do not send the form to the GIC.
EMPLOYEES WITHOUT HEALTH COVERAGE WHO DO NOT ENROLL DURING ANNUAL ENROLLMENT
If an employee does not elect health insurance during the GIC’s Annual Enrollment or during Your Agency’s Section 125 Plan Open Enrollment, he/she must complete a Health Insurance Responsibility and Disclosure (HIRD) form.
- Fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the most current GIC rate sheet.
- Verify that the employee has completed the form accurately and completely. If the employee refuses to complete the form, document efforts to obtain the information from the employee.
- Retain all HIRD forms for three years and make them available to the Health Connector upon request. Do not send the form to the GIC.
GIC RETIREE DENTAL
During Annual Enrollment, if you municipality offers the GIC Retiree Dental Plan, your retirees and survivors may enroll in coverage, change from individual to family, family to individual, or remove dependent(s) from their family Retiree Dental Coverage.
Let a retiree or survivor who is enrolling know that once enrolled, if he/she drops coverage, he/she may never re-enroll.
- Retiree or survivor completes and sends you the GIC Municipal Retiree Dental Enrollment/Change Form (Form-MRD).
- Sign the GIC Municipal Retiree Dental Enrollment/Change Form (Form-MRD).
- Photocopy the GIC Municipal Retiree Dental Enrollment/Change Form (Form-MRD) and file a copy in the retired employee’s personnel file.
- Send the original GIC Municipal Retiree Dental Enrollment/Change Form (Form-MRD) to the GIC by the Annual Enrollment deadline.
- Enter the dental deduction in your pension system for July 1 coverage.
This information provided by the Group Insurance Commission .
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