Update April 13, 2015
If the employee is changing from individual to family coverage, follow the below procedures:
- The employee must complete and sign the following:
- GIC Municipal Enrollment/Change Form (Form-1MUN)
Documentation of qualifying status change event required. To add a spouse or dependent also provide the following:
- 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 age 19 to 26 – Dependent Age 19 to 26 Enrollment/Change Form. For a handicapped dependent, a Handicapped Dependent Application. Birth certificates must accompany the forms and show parent-child relationship to the insured or his/her spouse.
- 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 forms and documentation of the qualifying status change event and file in the employee’s personnel file.
- Send original signed forms and documentation of the qualifying status change event to the GIC. Forms and documentation must be received at the GIC within 60 days of the qualifying event. Forms and documents received after 60 days are returned and the employee may re-apply during Annual Enrollment.
This information provided by the Group Insurance Commission .
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