Insurance
Forms
Forms must be completed and submitted to the GGUSD Insurance Dept. to process any change to your coverage for yourself and/or your dependents. *You must have a qualifying event to add / remove yourself and / or your dependents outside of Open Enrollment (mo. of Oct., effective Jan. 1). See forms below to be completed for enrollment or common changes; original signature required; must be received within 31 days of the qualifying event.
You will also need to provide: a copy of your recorded marriage certificate or registration of domestic partnership and birth certificates for your children.
When newly married, an updated Life Insurance Beneficiary Designation form must be submitted.
Please contact the Insurance Department with any questions.
Full Time Employees
Initial Enrollment
- Self-Insured Enrollment and Change Form
- Election and Authorization Form (effective during 2018)
- Election and Authorization Form (effective 1/1/2019)
- Life Insurance Beneficiary Designation Form - Full Time
- Anthem Blue Cross HMO Enrollment Form (ONLY if you choose in this plan)
- United Concordia Enrollment and Change Form (ONLY if you choose this plan)
Adding or Removing a Dependent
- Self-Insured Enrollment and Change Form
- Election and Authorization Form (ONLY if your deduction is changing; effective during 2018)
- Election and Authorization Form (ONLY if your deduction is changing; effective 1/1/2019)
- Life Insurance Beneficiary Designation Form (if newly married or changing beneficiary) – Full Time
- Anthem Blue Cross HMO Enrollment Form (ONLY if you are enrolled in this plan)
- United Concordia Enrollment and Change Form (ONLY if you are enrolled in this plan)
Waiving Benefits
- Election and Authorization Form (effective during 2018)
- Election and Authorization Form (effective 1/1/2019)
- Life Insurance Beneficiary Designation Form (if not previously submitted) – Full Time