Get Gic Retiree/survivor Enrollment/change Form (form-rs) - Mass

Filling out the Gic Retiree/survivor Enrollment/change Form (form-rs) requires careful attention to detail. This guide will walk you through each section of the form, ensuring that you understand what information is needed and how to provide it accurately.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Gic Retiree/survivor Enrollment/change Form (form-rs) and open it for editing.
2. Begin with the 'Insured Information' section. You will need to provide your GIC-ID, usually your Social Security number, followed by your address, date of birth, and contact information. Make sure to fill in all required fields accurately.
3. Next, check the 'Retirement Information' or 'Survivor Information' sections based on your applicable situation. Fill out your retirement details, including the department ID or agency/division number, and if applicable, the name of the deceased employee.
4. Indicate if you receive a monthly pension from a public retirement system by selecting 'Yes' or 'No'. If you have remarried, provide the date of your remarriage.
5. Select applicable options regarding your health coverage needs. You must indicate whether you are making a new enrollment, dropping dependents, or changing coverage due to qualifying status changes like marriage or birth/adoption.
6. Choose your Medicare or non-Medicare plan from the provided options based on your age and eligibility for Medicare, ensuring you check all necessary boxes that apply to you and your dependents.
7. If you are adding or dropping dependents, complete the 'Spouse/Dependent Information' section accordingly. Provide last names, Social Security numbers, dates of birth, sex, and relationships.
8. Sign the authorization section confirming your understanding of the terms and that you authorize your pension authority to deduct necessary amounts for your health coverage. Remember to include the required dates for both your signature and that of the authorized official.
9. Review all entered information for accuracy, ensuring that all required documentation is attached based on your circumstances, especially if adding dependents or if you and/or your spouse are Medicare eligible.
10. Finally, save your changes, download, print, or share the completed form as necessary. Ensure that you submit the form and any required documentation to the designated GIC address.

Complete your Gic Retiree/survivor Enrollment/change Form (form-rs) online to ensure your benefits are accurately processed.