Updated October 28, 2013
ADD A SPOUSE OR DEPENDANT
To add a spouse or dependent to health or dental/vision coverage, the insured must have family health or dental/vision coverage. If the insured does not have family coverage, refer to the procedure for Individual to Family Coverage Change .
If the insured already has family coverage, complete the following procedure:
- Employee completes the following forms completely and legibly:
- Required only for a name change: Employee Insurance Enrollment and Change (Form-1). Be sure the insured completes the name change section in addition to the top of the form and signature.
- Dependent Age 19 to 26 Form (if applicable)
- Handicapped Dependent Application (if applicable)
- Dental/Vision Enrollment and Change Form (Form-1) (if applicable)
- Attach copies of marriage and birth certificates. For newborn coverage, an announcement letter from the hospital can be used if a birth certificate is not yet available. The birth certificate or hospital notice must show parent-child relationship to the insured or his/her spouse.
- Photocopy all forms and documentation and file in the employee’s personnel file.
- Send original forms and the documentation to the GIC.
REMOVING A SPOUSE OR DEPENDENT UNDER AGE 19 – RETAINING FAMILY COVERAGE
- Employee completes the Enrollment/Change Form(Form-1) checking off the deletion box and listing spouse’s/dependent’s name, date of birth, relationship to insured, and Social Security Number.
- The employee must indicate the reason for the deletion, the effective date (this date cannot be retroactive), and include proof of other coverage.
- Photocopy the Enrollment/Change Form and proof of other health coverage and file in the employee’s personnel file.
- Send the original Enrollment/Change Form and proof of other coverage to the GIC.
This information provided by the Group Insurance Commission .
People also viewed...
You recently viewed...
Personalization is OFF. Your personal browsing history at Mass.gov is not visible because your personalization is turned off. To view your history, turn your personalization on.
Learn more on our .
*Recommendations are based on site visitor traffic patterns and are not endorsements of that content.