FAMILY MEMBERS (DEPENDENT)
Eligible dependents can be covered on many of our benefit plans. We'll need eligibility documentation such as a Federal Tax Return or Birth Certificate for all new dependents added to health and/or dental plans. This chart lists eligible dependents and which documents can be used to prove dependent eligibility for insurance coverage.
| DEPENDENT TYPE & DEFINITION |
REQUIRED DOCUMENTATION |
SPOUSE
The covered team members’s spouse according to the laws of the state where the team member lives or was married. |
OPTION 1
- Copy of most recent federal tax return showing spouse
(Front and signature pages only)
OPTION 2
- Marriage certificate; AND
- Proof of joint ownership dated within the past 60 days (e.g. joint bank statement, credit card, mortgage, etc.)
Social Security numbers and financial information can be marked out |
Domestic Partner
The covered team member's domestic partner according to the laws of the state where the team member lives. |
Official Certificate of Domestic Partnership signed by both partners (must be notarized). In addition, at least two of the following items must be submitted as proof of eligibility (must be in effect for at least one year prior)
- Joint mortgage or lease agreement;
- Notarized mutual assignment of POA for financial and medical;
- Joint checking or credit account;
- Formal commitment ceremony document; OR
- Primary beneficiary designation for will, life insurance, and/or retirement benefits.
|
DEPENDENT CHILD UNDER AGE 26*
Natural-born children or legally adopted children, whether or not such children live with the team member. |
NATURAL-BORN CHILD:
ADOPTED CHILD:
- Amended birth certificate naming employee as parent; OR
- Copy of adoption papers
|
| Step-children (as long as a natural parent remains married to and resides with the team member) |
STEP-CHILD
- Birth certificate; AND
- Proof of marriage to a natural parent (see required documents for Spouse above).
|
| Any child of a plan participant who is an alternate recipient under a qualified medical child support order shall be considered as having a right to dependent coverage under this plan. |
COURT-ORDERED COVERAGE FOR DEPENDENT:
- Final court order with presiding judge’s signature; OR
- Qualified Medical Child Support Order (QMCSO) showing date of birth
|
DISABLED CHILD (AGE 26+)
A covered child who reaches the limiting age (26 years old) and is totally disabled, incapable of self-sustaining employment by reason of mental or physical handicap, primarily dependent upon the covered team member for support and maintenance and unmarried. The plan administrator may require, at reasonable intervals during the two years following the dependent’s reaching the limiting age, subsequent proof of the child’s total disability and dependency. |
DISABLED CHILD
- Birth certificate; AND
- Physician letter with a statement of Total and Permanent Disability, completed and signed by the dependent’s physician (stamped signature not acceptable); AND
- Copy of current federal tax return (front and signature pages only); AND
- Copy of Supplemental Security Income (SSI) award, if eligible.
|
We can't add a dependent to your coverage if they're:
- in the armed forces. However, those on active military duty are eligible for coverage under TRICARE effective the date of their active-duty orders.
- an ex-spouse. Team members must cancel dependent coverage when the dependent no longer meets the eligibility requirements.
Changes After Enrollment
Once you enroll, the choices you make will stay the same through 2022. You can only make a change if you have an IRS-Qualifying Life Event such as:
- Marriage
- Divorce
- Birth
- Adoption
- Change in employment for you or your spouse
If you qualify, submit a Change Form (found on the Benefits website on CLICK) and supporting documentation such as a marriage or birth certificate, employer statement, etc. to verify your request within 31 days of the event. Otherwise, you'll have to wait until the next open enrollment period to make benefit changes.