When may you
enroll?
Eligible employees may enroll for health coverage upon:
• hire into a benefited position with the University
• during open enrollment each year (April/May with changes effective
July 1 of that year.)
• upon loss of health insurance coverage under another plan
Who may be covered?
As an enrolled employee you may cover your spouse and dependents on
the plan with some exceptions.
Dependent children over age 19 may continue coverage if they are
enrolled as a full-time student with an accredited educational institution
or if he/she is disabled. If not enrolled as a full-time student your dependent over
19 may be eligible for health insurance coverage. The value of the coverage will be a
taxable benefit to you. Please contact Benefits at 413.545.6115 with questions.
You will be required to furnish periodic confirmations
of your dependent's student or disability status in order for coverage
to continue.
1. Dependent Age 19 or Over Application For Continued Coverage
Your former spouse may be covered on your health insurance plan if required
by the Qualified Domestic Relations Order or Divorce Decree.
Enrolling in Heath Insurance Coverage
In order to enroll for health insurance coverage you must complete the
following forms and return them to the Human Resources information Center
(link to location/hours):
1. GIC
Enrollment and Change Form, and
2. if electing an
HMO or PPO, the corresponding plan's enrollment form, and the corresponding vendor's enrollment form;
Fallon
Community Health Plan Direct Care
Fallon
Community Health Plan Select Care
Health New England
(includes MedRate Plan)
Neighborhood
Health Plan
3. if electing family
coverage, you must also complete the IDF
form and provide a marriage certificate if covering a spouse and
a birth certificate / adoption certificate for each dependent child.
4. if enrolling
a dependent child over age 19 you must furnish (upon enrollment and
periodically thereafter) confirmation of the dependent's enrollment
as a full-time student with an accredited educational institution or
his/her disability. Student verification forms are available at the
GIC website: http://www.state.ma.us/gic/forms.htm
Add a dependent:
You may add your newborn or adopted child to your health insurance coverage
within 30 days of the child's birth/adoption/placement for care or during
open enrollment any year (coverage effective July 1st). Complete and
return the following forms to the Human Resources Information:
1. GIC
Enrollment and Change Form, and
2. if electing an HMO or PPO, the corresponding plan's enrollment form
(see above), and
3. IDF form
accompanied by your child's birth certificate / adoption certificate.
