An employee can change from family to individual coverage within 60 days of a qualifying status change event following the procedures below.
- The employee must complete and sign the following: GIC Municipal Enrollment/Change Form (Form-1MUN). The employee must provide documentation of the qualifying status change event. For example, in the case of death of spouse or dependent, a copy of the death certificate is required.
- Verify that the form is completed accurately and completely. Ensure that both you and the employee have signed and dated the form.
- Update your payroll system with the new premium deduction.
- Photocopy completed GIC form and documentation of qualifying status change event and file them in the employee’s personnel file
- Send original signed form to the GIC along with the documentation of the qualifying status change event. Forms and documentation received after 60 days of the event are returned and the employee may re-apply during Annual Enrollment.
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.
This information provided by the Group Insurance Commission .
People also viewed...
You recently viewed...
Personalization is OFF. Your personal browsing history at Mass.gov is not visible because your personalization is turned off. To view your history, turn your personalization on.
Learn more on our .
*Recommendations are based on site visitor traffic patterns and are not endorsements of that content.