Divorce

Divorce is a qualified Change in Family Status that allows you to make changes to your benefits. If you get divorced and your former spouse is covered under your health and/or dental insurance plan you must notify Benefits in the HR Service Center.

GIC Health Insurance

If you need to cancel coverage for your former spouse please complete the

GIC Insurance Enrollment and Change Form (Form 1) and the Insurance Data Form (IDF).

You must send these forms to Benefits in the HR Service Center along with a copy of the following sections of the divorce decree: page with the ‘divorce absolute’ date (the date your divorce became final), the health insurance provisions, and signature pages.

The GIC will provide you and your former spouse with information about your former spouse continuation of health insurance coveragethrough COBRA.

If you are divorced and are remarrying you must notify Benefits in the HR Service Center. If your former spouse is covered by your health insurance plan you must complete the IDF (Insurance Data Form) to cancel his/her coverage. Please send these forms with a copy of your new marriage certificate and your former spouse's last known home address to Benefits in the HR Service Center.

If your former spouse is included under your health insurance coverage and s/he is getting remarried, you must contact Benefits in the HR Service Center. You will need to send a letter with the remarriage date of your former spouse and your former spouse’s last known home address in writing to the Director of Operations at the Group Insurance Commission (GIC). Your former spouse may apply for COBRA coverage by completing the Dependent COBRA application and sending it directly to the GIC.

Dental Insurance

If you get divorced and your former spouse has coverage through your dental insurance you must submit the Dental Enrollment/Change Form to Benefits in the HR Service Center with a copy of the following sections of the divorce decree: page with the ‘divorce absolute’ date (the date your divorce became final), the dental insurance provisions, and signature pages.

The COBRA administrator will provide your former spouse with information about continuation of dental insurance coverage through COBRA.

(If you belong to the AFSCME, MNA, NAGE or NEPBA union, you have dental insurance with the union. Please contact the union for information).

 

GIC Life Insurance

If you want to change beneficiaries for your GIC life insurance you need to submit the GIC Life Insurance Beneficiary Designation Form. If you are designating four or more beneficiaries or for special designations (estate or trust), please submit the Nomination of Beneficiaries G-500. You may email the Benefits Service Center at Benefits.UMMS@umassmed.edu for either of these forms.

State Retirement System

If you want to change beneficiaries with the State Board of Retirement you must submit the Selection/Change of Beneficiary Form.

Please send the forms to:

Benefits-HR Service Center

UMMS 
333 South Street
Shrewsbury, MA 01545

Fax (508) 856-4049

For any questions, please send an email to benefits.umms@umassmed.edu or call (508) 856-5260, option 1.

Name Change

You must notify Human Resources if you make a legal name change. Please complete the Employee Record Change Form and submit it with a copy of your new social security card to:

HR Data Group-HR Service Center

UMMS 
333 South Street
Shrewsbury, MA 01545

For questions call (508) 856-5260, option 2.