Get the free GIC RETIREE/SURVIVOR ENROLLMENT/CHANGE FORM (FORM-RS) - mass.gov

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How to fill out gic retireesurvivor enrollmentchange form

How to fill out gic retireesurvivor enrollmentchange form

1. To fill out the GIC Retiree Survivor Enrollment/Change Form, follow these step-by-step instructions:
2. - Begin by downloading the form from the GIC website or contacting the GIC office to request a copy.
3. - Fill out the personal information section, including your name, address, Social Security number, and date of birth.
4. - Indicate whether you are a retiree or a survivor and provide the necessary details.
5. - If you are a retiree, specify your retirement date and the type of health plan you wish to enroll in.
6. - If you are a survivor, provide information about the deceased and the retiree's relationship to you.
7. - Specify the type of coverage you are requesting, such as individual or family, and select your desired health plan.
8. - If you wish to make any changes to your previous enrollment, clearly indicate the modifications.
9. - Review the form to ensure all information is accurate and legible.
10. - Finally, sign and date the form, and submit it to the GIC office either by mail or in person.

Who needs gic retireesurvivor enrollmentchange form?

1. The GIC Retiree Survivor Enrollment/Change Form is required for retirees and survivors who want to enroll in or make changes to their health insurance coverage through the Group Insurance Commission (GIC). Retirees and survivors who are eligible for GIC health insurance benefits must complete this form to indicate their enrollment preferences or update their existing coverage.

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What is gic retireesurvivor enrollmentchange form?

The GIC Retiree/Survivor Enrollment Change Form is a document used to make changes to the health insurance coverage of retirees and survivors participating in the Group Insurance Commission (GIC) program.

Who is required to file gic retireesurvivor enrollmentchange form?

Retirees and survivors participating in the GIC program are required to file the Retiree/Survivor Enrollment Change Form in order to make changes to their health insurance coverage.

How to fill out gic retireesurvivor enrollmentchange form?

The form can be filled out by providing personal information, selecting desired changes to the health insurance coverage, and submitting the form to the GIC program.

What is the purpose of gic retireesurvivor enrollmentchange form?

The purpose of the form is to allow retirees and survivors in the GIC program to make changes to their health insurance coverage as needed.

What information must be reported on gic retireesurvivor enrollmentchange form?

The form requires personal information, details of current health insurance coverage, and desired changes to the health insurance coverage to be reported.