New Hire

New employees must make their benefit elections within ten (10) calendar days of the employee's first days of employment. To select their benefits, employees must complete the following forms completely and legibly:

  • Insurance Enrollment and Change Form (Form-1).
  • Beneficiary Designation Form 319 (one to three beneficiaries) or Nomination of Beneficiary Form G-500 (four or more beneficiaries or special designations such as estate or trust).
  • Insurance Data Form (IDF) for family coverage. Must also provide:
    • For spousal coverage - copy of marriage certificate.
    • For former spouse - provide following sections of the legal separation or divorce decree: page with absolute date, health insurance language, signature pages, and former spouse's address.
    • For dependent coverage under age 19 - copy of birth certificate(s) - the GIC must be able to link the dependent to the insured or his/her spouse.
    • For dependent coverage age 19 or over - Dependent Age 19 to 26 Enrollment Application and a copy of birth certificate
  • Employee Acknowledgement form.
  • Health Care Spending Account/Dependent Care Assistance Program application.

NOTE: Advise the new employee that if he/she does not elect optional life insurance coverage when first eligible or does not elect the maximum amount available, he/she may apply at any time thereafter, but will be required to provide proof of good health to the life insurance carrier unless the employee has a qualified family status change (see Late Enrollment Section for details).

NOTE: Advise the new employee that if he/she does not elect Long Term Disability coverage when first eligible, he/she may apply at any time thereafter, but will be required to provide proof of good health to the LTD carrier (see Late Enrollment Section for details).

All new employees should automatically be enrolled in pre-tax health insurance deductions unless they opt out of participating. This is known as a Section 125 Plan. If the employee elects to opt out, he/she must complete the Pre-Tax Basic Life and Health Insurance Plan Election Not To Participate Form.

  • Verify that the forms are completed accurately and completely. Ensure that the employee has checked the information entered on his/her forms, and has signed and dated all forms.
  • Photocopy completed GIC forms and file them in the employee's personnel file. File original Employee Acknowledgement form in employee's personnel file. Do not send this form to the GIC.
  • Send all other original signed forms to the GIC.
  • Update your payroll system with the new basic life and health premium deductions. If HCSA or DCAP is selected, send the form to the FSA carrier; do not send this form to the GIC.

New Employees Who Do Not Elect GIC Health Insurance

If a new employee does not elect GIC health insurance, he/she must complete a Health Insurance Responsibility Disclosure (HIRD) form:

  • Fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the most current GIC rate sheet.
  • Verify that the employee has completed the form accurately and completely. If the employee refuses to complete the form, document efforts to obtain the information from the employee.

Retain all HIRD forms for three years and make them available to the Division of Health Care Finance and Policy upon request. Do not send the form to the GIC.


This information provided by the Group Insurance Commission .