Health Insurance

All Employees

Q. What is the GIC?
A. The Group Insurance Commission (GIC) provides and administers health insurance and other benefits to the Commonwealth’s employees and retirees, as well as their dependents and survivors. The GIC also covers housing and redevelopment authorities’ personnel, participating municipalities, and retired municipal employees and teachers in certain governmental units.

Q. How do I know if I am eligible for GIC benefits?
A. According to Massachusetts law, permanent employees are eligible for GIC benefits. Employees must work at least 18.75 hours in a 37.5-hour workweek or 20 hours in a 40-hour workweek. The employee should also contribute to City Retirement System or MTRS.

Q. When are premiums deducted?
A. All GIC premium deductions are taken one month in advance of coverage.

Q. I am a new employee. When will my coverage begin?
A. New employee coverage begins on the first day of the month following 60 calendar days from the first date of employment, or 2 calendar months, whichever comes first.

Date of employment is from:

01/02 – 02/01 Coverage begins on: 04/01

02/02 – 03/02 Coverage begins on: 05/01

03/03 – 04/02 Coverage begins on: 06/01

04/03 – 05/02 Coverage begins on: 07/01

05/03 – 06/02 Coverage begins on: 08/01

06/03 – 07/03 Coverage begins on: 09/01

07/04 – 08/02 Coverage begins on: 10/01

08/03 – 09/02 Coverage begins on: 11/01

09/03 – 10/02 Coverage begins on: 12/01

10/03 – 11/02 Coverage begins on: 01/01

11/03 – 12/03 Coverage begins on: 02/01

12/04 – 01/01 Coverage begins on: 03/01

Q. I am a new employee. Can I apply for late enrollment during my 60 days new hire waiting period?
A. No.

Q. I am leaving my current private sector job and will be eligible for GIC health insurance as a new hire in 60 days. What should I do about health insurance coverage during the 60-day waiting period?
A. The GIC recommends that you elect COBRA coverage through your former employer so that you have health insurance during the 60-day new hire waiting period. If you do not have COBRA coverage, you may be eligible to purchase health insurance through the Health Connector.

Q. During my GIC 60-day new hire waiting period, I (or my dependent) have had catastrophic medical expenses and do not have other health insurance or access to COBRA coverage through my former employer. Do I have any options to help cover these expenses?
A. If you or your dependent has an unplanned and urgent medical expense that exceeds the state’s or municipal’s full cost premium and this medical expense occurs on or after the first day of employment or waiting period but before the effective date of coverage, you can purchase coverage during your waiting period at the full cost premium. This option is sometimes called a B Waiver. Your coverage will be dependent on timely receipt of the full cost premium payment and approval from the health plan. Contact the GIC’s Public Information Unit at 617.727.2310 Ext. 1 for more information.

Q. I was on a different plan before coming to Framingham. Can I keep my doctor?
A. When considering your health plans, verify with your physician’s office which GIC health plans they accept. It is likely you will be able to use your same hospital although the co-pays and deductibles may vary from hospital to hospital.

Q. What are the plans?
A. The GIC currently has 14 plans, including several HMOs, PPO’s and Indemnity plans. They also have Medicare supplemental plans.

Q. What if my dependent doesn’t have a social security number?
A. You will need to apply for one through social security as soon as possible.

Q. I was on one GIC health plan last year but now want to change to a different one. Can I?
A. Yes, but you will need to wait for Open Enrollment in April and May. We will make an announcement.

Q. I don’t want to change my GIC health plan. Do I still need to submit paperwork?
A. No. If you want to keep your current GIC health plan, you do not need to fill out any paperwork. Your coverage will continue automatically.

Q. Is it possible that co-pays, benefits, and premiums of my current GIC plan have changed?
A. Yes. Do your homework during annual enrollment, even if you don’t plan to make any changes. Benefits and rate changes can change effective July 1 of each enrollment year. Co-pay tiers can also change each July 1 with new data. Contact the plans to find out if your doctors and hospitals still participate in your plan. Specify the plan’s full name. For instance, say “Harvard Pilgrim Primary Choice Plan” or “Harvard Pilgrim Independence Plan,” not just Harvard Pilgrim.

Q. How can I save money?
A. Consider enrolling in a limited network plan to save money every month on your premiums. These plans have the same benefits as the wider network plans but save money because they have fewer physicians, hospitals, and other providers.

Q. I chose a plan but now want to switch. Can I?
A. Once you choose a health plan, you cannot change plans during the year, unless you (1) have a qualifying status change (or “qualifying event”), (2) move out of the plan’s service area, or (3) are retiring and become eligible for Medicare (in which case you must enroll in a Medicare plan).

Q. What is a qualifying status change (or “qualifying event”)?
A. Qualifying events include marriage, birth, adoption, court order/judgment, spouse’s annual enrollment, or loss of health insurance elsewhere. Upon the occurrence of a qualifying event, you can enroll in GIC coverage at any time during the year with proper documentation (i.e. marriage certificate, birth announcement, letter from an employer, etc.). However, acceptable documentation of the qualifying event and the Enrollment/Change form must be received at the GIC within 60 days of the qualifying event. That means the Office of Human Resources needs to receive your documentation within 30 days of the qualifying event.

Q. Can I fax or scan my insurance forms?
A. No. The GIC accepts ORIGINAL forms and signatures ONLY!

Q. I just had a baby. What should I do?
A. You ONLY have 30 days from the day of the child’s birth to add him/her to your health insurance. Please notify the Office of Human Resources right away, so we can send you the necessary forms. Go to TalentEd and click on “Blank Docs”; choose the “Birth Notification Form”. You will need to send in forms with original signatures as well as the birth announcement to the Office of Human Resources so we can add the baby to the insurance. The GIC is VERY strict about these 30 days!

Q. My doctor and/or hospital left my health plan, can I switch health plans?
A. No. If your doctor or hospital leaves your health plan, you must find a new participating provider in your chosen plan.

Q. I am leaving the district. When will my GIC coverage end?
A. Your health coverage ends at the end of the month following the month you end your employment.

Date employment ends:

01/01 – 01/31 GIC coverage end date: 02/28

02/01 – 02/29 GIC coverage end date: 03/31

03/01 – 03/31 GIC coverage end date: 04/30

04/01 – 04/30 GIC coverage end date: 05/31

05/01 – 05/31 GIC coverage end date: 06/30

06/01 – 06/30 GIC coverage end date: 07/31

07/01 – 07/31 GIC coverage end date: 08/31

08/01 – 08/31 GIC coverage end date: 09/30

09/01 – 09/30 GIC coverage end date: 10/31

10/01 – 10/31 GIC coverage end date: 11/30

11/01 – 11/30 GIC coverage end date: 12/31

12/01 – 12/31 GIC coverage end date: 01/31