HIRD Form Instructions:
For GIC-eligible employees, the Payroll Department or GIC Coordinator must fill in the lowest available monthly employee share of GIC health insurance individual coverage premium using the current GIC rate chart. The lowest cost plan and the rates will change each year.
The employee must return the form to their Payroll Department or GIC Coordinator. Do not return the form to the GIC. You must retain these forms for three years and make them available to the Division of Health Care Finance and Policy upon request. We suggest that you keep all HIRD forms in a single file in alpha order for ease of look up.
If an employee refuses to return the form to you, you must document your efforts to obtain it.
HIRD Form Distribution Ongoing:
- New Hires: Add the HIRD form to your new hire package. Every time you hire a new employee who is not GIC-eligible and does not elect to participate in your agency's Section 125 Cafeteria Plan, or is eligible for GIC benefits and does not take GIC health insurance, you must have the employee complete and return to you the HIRD form within 30 days.
- Withdrawal from coverage: If you have an employee who drops GIC health insurance or your agency's Section 125 Cafeteria Plan coverage (e.g., obtains health insurance elsewhere, does not pay their health premiums, or goes on a military leave), you must give the employee a HIRD form to complete and return to you.
- Annual enrollment: Employees who do not elect coverage during the GIC's annual enrollment or your agency's Section 125 plan's open enrollment must complete a HIRD form within 30 days of the end of those open enrollment periods.
This information provided by the Group Insurance Commission.