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 Insurance Enrollment and Change (Form-1)
  • Insurance Data Form (IDF)
    • For spousal coverage – copy of marriage certificate. (Note: Due to differences between federal and state law, if an insured is adding a same-sex spouse, the insured is subject to imputed income.  Please advise the employee accordingly.)
    • 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.
  • Beneficiary Designation Form (Form 319 or G-500) – if requesting a change

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 and Vision Enrollment and Change form – See Dental/Vision section for eligibility.  If family coverage is not elected for health insurance, but the employee wishes to have dental/vision coverage, he/she must also submit copies of the documents listed under the Insurance Data Form (IDF) above.

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.

This information provided by the Group Insurance Commission .