COBRA Coverage

If you are an employee of the Commonwealth of Massachusetts, you have the right to choose COBRA coverage if you lose your group health coverage because your hours of employment are reduced or your employment ends for reasons other than gross misconduct.

If you are a municipal employee with health coverage through the GIC, you have the right to choose COBRA coverage if you lose your group health coverage because your hours of employment are reduced or your employment ends for reasons other than gross misconduct.

If you are the spouse of an insured covered by the GIC's health benefits program, you have the right to choose COBRA coverage for yourself if you lose GIC health coverage for any of the following reasons (known as "qualifying events"): Your spouse dies; your spouse's employment with the Commonwealth or participating municipality ends for any reason other than gross misconduct or his/her hours of employment are reduced; or you and your spouse divorce or legally separate.

If you have dependent children who are covered by the GIC's health benefits program, each child has the right to elect COBRA coverage if he or she loses GIC health coverage for any of the following reasons (known as "qualifying events"): the parent dies; the employee-parent's employment is terminated (for reasons other than gross misconduct) or the parent's hours of employment are reduced; the parents legally separate or divorce; or the dependent ceases to be a dependent child under GIC eligibility rules.  

COBRA General Notice - GIC enrollees receive this notice in their health plan handbook to advise them of their rights under COBRA upon employment termination or family status changes.

For Coverage Terminated On Or After June 30, 2024

COBRA General Application – use this form to apply for COBRA health insurance benefits if your coverage is terminated on or after June 30, 2024.

COBRA Dental/Vision Application - use this form to apply for COBRA dental and vision if your coverage was terminated on or after June 30, 2024.

COBRA Retiree Dental Application - use this form to apply for COBRA Retiree Dental if your coverage was terminated on or after June 30, 2024.

For Coverage Terminated On Or After June 30, 2023

COBRA General Application – use this form to apply for COBRA health insurance benefits if your coverage is terminated on or after June 30, 2023.

COBRA Dental/Vision Application - use this form to apply for COBRA dental and vision if your coverage was terminated on or after June 30, 2023.

COBRA Retiree Dental Application - use this form to apply for COBRA Retiree Dental if your coverage was terminated on or after June 30, 2023.