If an employee does not elect health insurance during the GIC’s annual enrollment or during Your Agency’s Section 125 Plan Open Enrollment, he/she must complete a Health Insurance Responsibility and Disclosure (HIRD) form.

  1. Fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the most current GIC rate sheet.
  2. 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.
  3. Retain all HIRD forms for three years and make them available to the Health Connector upon request.  Do not send the form to the GIC.

This information provided by the Group Insurance Commission .

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