If an employee moves out of or resides outside of a health plan’s service area, he/she must change health plans.  To process this change:

  1. Have employee complete Municipal Insurance Enrollment and Change Form (Form-1MUN) indicating their choice of new health plan.
  2. Obtain from employee proof of address change, such as utility bill or Purchase and Sale agreement.
  3. Photocopy forms and proof of address change and file them in employee’s personnel file.
  4. Send proof of address change and original signed Municipal Insurance Enrollment and Change Form (Form-1MUN) to the GIC.
  5. The GIC will determine the coverage effective date for this change.

If an employee’s covered spouse, former spouse and/or dependent(s) moves outside or resides outside of the employee’s health plan’s service area, the entire family must change health plans to a plan that will cover the employee and his/her dependents where they reside.  (Only unmarried full-time students may reside outside of a health plan’s service area.) Note that only UniCare/Basic is available throughout the country and outside of the U.S.  To change the family’s coverage to a new health plan:

    1. Have employee complete the Municipal Insurance Enrollment and Change Form (Form-1MUN) checking UniCare/Basic as their choice of a new health plan if that is the only plan available.
    2. Obtain from the employee proof of the former spouse’s address.  For dependent age 19 to 26, have the employee complete a Dependent Age 19 to 26 Enrollment and Change Form indicating the dependent’s address.
    3. Photocopy forms and file in the employee’s personnel file.
    4. Send the original forms and proof of addresses to the GIC.
    5. The GIC will determine the coverage effective date of this change.

This information provided by the Group Insurance Commission .