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 .