For insureds who want to cancel their GIC health insurance and/or dental/vision coverage due to a qualifying status change event:

Documentation of qualifying status change is required.

  1. Employee completes and signs GIC Enrollment/Change Form (Form-1) with appropriate cancel coverage box(es) checked.  For dental/vision, the employee completes the Dental/Vision Enrollment/Change Form (Form-1DV).
  2. If the employee is withdrawing from health insurance, the employee must provide documentation of the qualifying status change event.
  3. Review and sign Enrollment/Change Form (Form-1) and Dental/Vision Form-1, if applicable.
  4. Update your payroll system deductions.
  5. Photocopy Enrollment/Change Form (Form-1) and Dental/Vision Form-1DV, if applicable, and documentation of qualifying status change event and file in employee’s personnel file.
  6. Send original Enrollment/Change Form (Form-1) and Dental/Vision Enrollment/Change Form (Form-1DV), if applicable, documentation of qualifying status change event, to the GIC within 60 days of the qualifying status change 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 .