GIC Forms

GIC Forms


FY 18 GIC Forms and Rates

GIC MUNICIPAL ENROLLMENT/CHANGE FORM (FORM-1MUN) This form (Form-1MUN) is for enrolling in or changing your election of health insurance. Use this form as a new hire, at Annual Enrollment, within 60 days of a documented qualifying status change, name and address changes, and for divorce and remarriage notifications. Use this form to add or drop your spouse and dependent(s) from coverage during Annual Enrollment and within 60 days of a documented qualifying status change.

GIC MUNICIPAL EMPLOYMENT STATUS CHANGE FORM (FORM-1AMUN) This form is for when you have an employment status change including transferring to or from your municipality, terminating municipal employment, and at retirement.

 

 

 

 
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PDF icon Click for current GIC Rates27.34 KB