Dependent Verification Documentation
Please plan to bring at least ONE of the following for each newly enrolled or not previously verified dependent that is enrolled in your medical plan. You will also need the names, birth dates and social security numbers of your dependents.
Proof of Marital Status
q Marriage Certificate
q 1st page of jointly files tax return
q 1040 form
q E-file confirmation page
q Tax Extension Form
Proof of Domestic Partnership
q Affidavit of same-sex domestic partnership provided by your state of residence.
Proof of Loss of Coverage
q Statement of credible coverage from your previous Carrier for anyone that will be added to our plan.
Proof of Dependent Relationship
q Birth certificate showing you, your spouse and/or same-sex domestic partner as the child’s parent
q Certified court approved adoption papers
q Placement letter from court/adoption agency
q Certified court ordered custody/guardianship papers
To obtain a copy of vital records such as birth certificates, death certificates, or marriage license, use the following link:
http://www.cdc.gov/nchs/w2w.htm