For an insured who wishes to cancel health insurance due to a qualifying status change event:

Documentation of qualifying status change event is required.

  1. Employee completes and signs GIC Municipal Enrollment/Change Form (Form-1MUN) with appropriate cancel coverage box checked.
  2. If employee is withdrawing from health insurance, the employee must provide documentation of the qualifying status change event.
  3. Review and sign Municipal Enrollment/Change Form (Form-1MUN).
  4. Update your payroll system deductions.
  5. Photocopy Municipal Enrollment/Change Form (Form-1MUN) and documentation of qualifying status change and file in employee’s personnel file.
  6. Send original Municipal Enrollment/Change Form (Form-1MUN), and documentation of qualifying status change event to the GIC within 60 days of the qualifying status change 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 .