For an insured who wishes to cancel health insurance:.

  1. Employee completes and signs GIC Municipal Insurance Enrollment and Change Form (Form-1MUN) with appropriate cancel coverage box checked. 
  2. If employee is withdrawing from health insurance and he/she has family coverage, the employee must provide proof of where spouse and/or dependents will be covered once GIC coverage is cancelled.  Acceptable proof examples: a copy of the health insurance card or a letter from the spouse’s employer on their letterhead.  Without this proof, the GIC can deny the request to withdraw from coverage. 
  3. Review and sign Municipal Insurance Enrollment and Change Form (Form-1MUN).
  4. Update your payroll system deductions.
  5. Photocopy Municipal Insurance Enrollment and Change Form (Form-1MUN) and proof of other coverage (if applicable) and file in employee’s personnel file.
  6. Send original Municipal Insurance Enrollment and Change Form (Form-1MUN) and proof of other coverage (if applicable) to the GIC.
  7.  The GIC will mail to the insured’s home a HIPAA Notice that includes a Certificate of Creditable Coverage indicating the coverage end date.

This information provided by the Group Insurance Commission .