For insureds who want to cancel their GIC life and/or health insurance coverage:
  1. Employee completes and signs GIC Insurance Enrollment and Change Form (Form-1) with cancel coverage box(es) checked and a Health Insurance Responsibility Disclosure (HIRD) form.
  2. Fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the most current GIC rate sheet on the HIRD form.
  3. If employee is withdrawing from health insurance and he/she has family coverage, the employee must provide proof of where spouse and/or dependents will be covered once GIC coverage is cancelled. Acceptable proof examples: a copy of the health insurance card or a letter from the spouse's employer on their letterhead. Without this proof, the GIC can deny the request to withdraw from coverage. In the case of death, a copy of the death certificate is required.
  4. Verify that the employee has completed the forms accurately and completely. If the employee refuses to complete the HIRD form, document efforts to obtain the information from the employee.
  5. Retain all HIRD forms for three years and make them available to the Division of Health Care Finance and Policy upon request. Do not send the form to the GIC.
  6. Review and sign Insurance Enrollment and Change Form (Form-1).
  7. Photocopy Insurance Enrollment and Change Form (Form-1) and proof of other coverage (if applicable) and file in employee's personnel file.
  8. Send original Insurance Enrollment and Change Form (Form-1) and proof of other coverage (if applicable) to the GIC.
  9. Update your payroll system deductions.
This information provided by the Group Insurance Commission.