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

Documentation of qualifying status change is required.

  1. Employee completes and signs GIC Municipal Enrollment/Change Form (Form-1MUN) with appropriate cancel coverage box checked and attaches documentation. 
  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 Enrollment/Change Form (Form-1MUN).
  4. Update your payroll system deductions.
  5. Photocopy Municipal Enrollment/Change Form (Form-1MUN) and proof of other coverage (if applicable) and file in employee’s personnel file.
  6. Send original Municipal Enrollment/Change Form (Form-1MUN), documentation of qualifying status change, and proof of other coverage (if applicable) to the GIC within 60 days of the qualifying event.  Forms received after 60 days are returned and the employee may re-apply during Annual Enrollment.

This information provided by the Group Insurance Commission .