If the employee is changing from individual to family coverage, follow the procedures below.

The employee must complete and sign the following:

For health insurance:

  • GIC Enrollment/Change Form (Form-1)

Documentation of qualifying status change required.  To add a spouse or dependent also provide the following:

    • 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 birth certificate must show the parent child relationship to the insured or his/her spouse.
    • For dependent age 19 to 26 – Dependent Age 19 to 26 Enrollment and Change Form and a copy of birth certificate. For a handicapped dependent, a Handicapped Dependent Application and a copy of birth certificate. The birth certificate must show parent-child relationship to the insured or his/her spouse.

For Dental/Vision:

A few of the GIC’s offline agencies are eligible for GIC Dental/Vision.  See the Dental/Vision Eligibility Section for details.

  • Dental/Vision Enrollment/Change Form (Form-1DV) – See Dental/Vision section for eligibility details.  Documentation of qualifying status change required.  If family coverage is not elected for health insurance, but the employee wishes to have dental/vision coverage, he/she must also submit a copy of a marriage certificate to cover a spouse and a birth certificate to cover dependent children and a Enrollment/Change Form for dependent age 19 to 26.

For all changes:

  1. Verify that the forms above are completed accurately and completely.  Ensure that both you and the employee have signed and dated all forms.
  2. Update your payroll system with the new premium deductions.
  3. Photocopy completed GIC forms and file them in the employee’s personnel file.
  4. Send original signed forms to the GIC.  Forms and documentation must be received at the GIC within 60 days of the qualifying event.  Forms and documents received after 60 days are returned and the employee may re-apply during Annual Enrollment.

This information provided by the Group Insurance Commission .