Get the free GIC MUNICIPAL ENROLLMENTCHANGE FORM - Wakefield

This document contains both information and form fields. To read information, use the Down Arrow from a form field. GIG MUNICIPAL ENROLLMENT/CHANGE FORM (FORM1MUN) Health Insurance INSURED INFORMATION

How to fill out gic municipal enrollmentchange form

How to Fill Out GIC Municipal Enrollment Change Form?

1. Begin by obtaining a copy of the GIC Municipal Enrollment Change Form from your municipal government office or their website.
2. Fill in your personal information, including your full name, address, contact number, and email address in the designated fields.
3. Provide your GIC member ID number, which can usually be found on your existing GIC enrollment card or through your employer.
4. Indicate whether you are a new member enrolling in the GIC or if you are making changes to your existing enrollment.
5. If you are making changes to your enrollment, specify the type of change you wish to make, such as adding or removing dependents, changing health plan options, or updating your personal details.
6. Provide the necessary details for the changes you are making. For example, if you are adding a dependent, include their full name, date of birth, relationship to you, and any other required information.
7. If you are opting for a new health plan, select the desired plan from the provided options and indicate if you are choosing individual or family coverage.
8. Review all the information you have provided to ensure accuracy and completeness.
9. Sign and date the form to acknowledge that the information provided is true and accurate to the best of your knowledge.
10. Submit the completed GIC Municipal Enrollment Change Form to the designated office or follow the instructions for online submission, if applicable.

Who needs GIC Municipal Enrollment Change Form?

1. Employees or individuals who are eligible for benefits through the GIC (Group Insurance Commission) may need to complete the GIC Municipal Enrollment Change Form.
2. Those who need to enroll in a GIC health plan for the first time or make changes to their existing enrollment, such as adding or removing dependents or changing health plan options, will require this form.
3. Municipal employees and their eligible dependents, such as spouses and children, who are covered under the GIC health insurance program may need to fill out this form to update their enrollment information or make any necessary changes.

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