Event Documentation Requirements

Annual Enrollment

Closed enrollment for a spouse, with the exception of Vision Hardware and supplemental life/AD&D coverage

Proof of legal Marriage/Common-Law Marriage - within 63 days of the event,

AND

Documentation to verify dependent eligibility for any new dependents being added to coverage due to the event (see below).

Proof of loss of eligibility for other coverage, which verifies the loss and the date the other coverage ends - within 63 days of the event,

AND

Documentation to verify dependent eligibility (see below).

No documentation is required for a natural child, stepchild, or legally adopted child (under age 26), as the process occurs automatically to remove the child from coverage based on DOB of the child.

A child who has a court-ordered permanent legal custody or court-ordered legal guardianship will be manually removed when they reach age 18.

Covered Disabled Dependent Child (Age 26+)

Children 26+ cannot be added to coverage

The child’s incapacity must be determined before the date the unmarried child’s coverage would otherwise terminate (age 26).

The child must be dependent upon the Subscriber for support and maintenance and be incapable of self-supporting employment.

Proof the child is dependent upon the Subscriber, must be submitted to the Plan within 31 days of the date the child’s coverage would otherwise terminate (age 26). The Social Security Administration (SSA) must have determined that the child is disabled and qualifies for disability benefits through Social Security Disability Insurance (SSI) or Supplemental Security Insurance (SSI),

AND

Copy of the front page of the most recent tax-return which indicates the disabled child is a qualified tax dependent. (Any financial information may be blacked out.)

Re-certification of the covered disabled dependent child’s incapacity will be required annually.

Marriage certificate or completed affidavit of common-law marriage (with notary seal/stamp and stamp from the county clerk and recorder’s office showing the date the affidavit was filed),

OR

Copy of the front page of the most recent tax-return showing the tax filing status as “Married”. (Any financial information may be blacked out.)

Legally separated or divorced spouses are not eligible for coverage.

For each dependent child being enrolled:

Copy of a birth certificate/hospital birth record (until age 26), adoption order or pre-adoption papers (prior to age 18),

OR

Copy of the front page of the most recent tax-return showing the child as a tax dependent (based on eligible child age restrictions). (Any financial information may be blacked out.),

OR

Documentation of the court-ordered legal guardianship or the court-ordered legal custody (until reaching age 18), or a court-ordered Qualified Medical Child Support Order (QMCSO).

A disabled dependent child age 26+ cannot be added to coverage.

For each dependent stepchild being enrolled:

Documentation listed above for a legal spouse/common-law spouse if the spouse is not enrolled,

AND

Copy of a birth certificate/hospital birth record (until age 26), adoption order/pre-adoption papers (prior to age 18),

OR

Copy of the front page of the most recent tax-return showing the child as a tax dependent (based on eligible child age restrictions). (Any financial information may be blacked out.),

OR

Documentation of the court-ordered legal guardianship, the court-ordered legal custody, or a court-ordered Qualified Medical Child Support Order (QMCSO).

A disabled dependent child age 26+ cannot be added to coverage.