- Employee completes the Municipal Enrollment/Change Form (Form-1MUN) checking off the deletion box and listing the dependent’s name, date of birth, relationship to insured, and Social Security Number and attaching documentation of qualifying status change event.
- The employee must indicate the reason for the deletion, and effective date (this date cannot be retroactive)..
- Photocopy the form and documentation of the qualifying status change event and file in the employee’s personnel file.
- Send the original form and documentation of the qualifying status change event to the GIC within 60 days of the qualifying event. Forms and documentation received after 60 days are returned and the employee may re-apply during Annual Enrollment.
This information provided by the Group Insurance Commission .