Get Gic Form 1a

Filling out the GIC Form 1a is an essential step for managing changes in employment status, such as retirement or transfers. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to fill out the GIC Form 1a online

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering your insured information. This includes your GIC-ID, sex, name (last and first), date of birth, and contact information such as home or cell phone, work phone, and email.
3. Provide your address, including street, city, state, zip code, and country (if not in the USA). Indicate your department ID number or agency/division number as required.
4. Next, fill in the employment information by stating the number of work hours per week and your date of hire. Additionally, mention the name of the municipality where you are employed or retiring from.
5. For transfer or termination details, provide the effective date, name of the agency or municipality from which you are transferring, last day of work, and the new agency or municipality you are transferring to, if applicable.
6. If relevant, select the termination reason and indicate if you wish to elect coverage options related to layoff, COBRA, or conversion.
7. For retirement, enter the retirement date, premiums paid through, and select your health insurance election options, if applicable. Be sure to check any Medicare eligibility boxes as appropriate.
8. Finally, read the authorization statement, sign, and date the form. Make sure to include any required signatures from authorized officials if necessary.
9. Once completed, save your changes, and choose to download, print, or share the form as needed.

Complete your GIC Form 1a online today to manage your employment status effectively.