These forms are intended for use by GIC members who choose to print and mail forms. Forms should be completed and submitted during GIC's Annual Enrollment or within 60 days of a qualifying event. GIC members can review benefit options and enroll in/update coverage for benefits effective July 1, 2025.

Save time and paper by updating or correcting your benefit statement on the MyGICLink Member Benefits Portal at bit.ly/Mygiclink (preferred). SECTION 1. MEMBER INFORMATION. SECTION 2. PLEASE CHECK ALL THAT APPLY AND PROVIDE THE INFORMATION REQUIRED. I request a birth date correction for: MUST SEND: Copy of corresponding birth certificate(s).

New Hire: Completed forms and required documentation must be received by the GIC within 21 days of your hire date. If you miss the deadline, you must wait until the next Annual Enrollment period to enroll in GIC basic life and health insurance benefits.

New Hire: Completed paperwork and required documentation must be received by your GIC Coordinator no later than your 10th calendar day of regular, benefit eligible employment.

Use this Form-1AMUN for all employment status changes including retirement. If enrolling in GIC health insurance coverage for the first time at retirement, you must also complete and return Form-RS. For GIC retiree benefits, see the GIC Benefit Decision Guide mass.gov/gic-municipal-employee-benefits.

Use this Form-RS to make GIC health plan changes for a qualifying s tatus change, at Annual Enrollment, and for enrolling in GIC health insurance for the first time at retirement.

2024年4月3日 · All GIC enrollment forms must be received in the Benefits Office no later than Wednesday, May 1, 2024 at the close of business (4:00PM EST). If you prefer to submit a paper form, the GIC still requires a wet signature; no copies, emails, or faxes are allowed at this time for paper forms. If you wish to enroll, change, or opt out of any of.

Most enrollment and change requests can be submitted to the MA Group Insurance Commission (GIC) online via the MyGIC Portal. When that is not possible the paper GIC Enrollment/Change Form (Form 1) can be completed and submitted to UMass Amherst Human Resources for processing and submission to the GIC.

municipal enrollment/change form (form-1mun) instructions For an overview of your GIC benefit options, see your GIC Benefit Decision Guide mass.gov/gic/bdgs. Deadlines and Required Documentation

GIC EMPLOYMENT STATUS CHANGE FORM (FORM-1A) INSTRUCTIONS Use this Form-1A for all employment status changes including retirement. If enrolling in GIC health insurance coverage for the first time at retirement, you must also complete and return Form-RS. For GIC retiree benefits, see the GIC Benefit Decision Guide www.mass.gov/gic/bdgs. Leave of ...