GIC Open Enrollment/Change Form 1

The MA Group Insurance Commission (GIC) Enrollment/Change Form 1 is used by GIC-eligible employees to modify health and/or optional life insurance coverage or add/remove dependents from health insurance within 60 days of a qualifying event.

This form can also be used to apply for long-term disability and/or optional life insurance coverage at any time. Note that the GIC's long-term disability and life insurance vendor approve or deny applications for coverage based on a medical evidence of insurability review. A medical questionnaire will be sent to your home by the insurance vendor. You must complete and return that form to the vendor timely in order to pursue your request for coverage.