I. Spouse
Proof of Marital Relationship:
- Government issued marriage certificate or license; or
- Naturalization papers indicating marital status
and one of these additional documents*:
• Bank statement issued within the last six months with both names; or
• Mortgage statement issued within the last six months with both names; or
• Residential lease agreement within the current terms with both names; or
• Credit card Statement issued within the last six months with both names; or
• Property tax statement issued within the last 12 months with both names; or
• The first page of most recent federal tax return filed showing “married filing jointly” or married filing separately” with the name of the spouse provided thereon; submit page 1 of the return with the income figures blacked out
* If married within the previous 12 months, only the marriage certificate or license is needed for proof of eligibility
II. Natural (biological) child under age 26
- The child’s birth certificate (will accept mother’s copy from the hospital for newborn); or
- Certificate of Report of Birth (DS-1350); or
- Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240); or
- Certification of Birth Abroad (FS-545)
III. Adopted child under age 26
- Final court order granting adoption; or
- International adoption papers from country of adoption; or
- Court order placing child in custody of member for purpose of adoption
IV. Child under age 18 placed for guardianship or custody with the head of contract
Valid order by a court of competent jurisdiction (placement order) establishing guardianship,
or custody between minor child and head of contract; and a certification signed by the head of contract upon initial enrollment and upon request.
If a minor child is on the state plan coverage before turning age 18 due to a guardianship or custody order, the child may be eligible to remain on the plan between age 18 and 26 if certain conditions are met. Additional facts are required and an additional certification must be signed by the head of contract.
V. Stepchild under age 26
Verification of marriage between employee and spouse (as outlined above) and birth
certificate of the child showing the relationship to the spouse, or documents determined by
Benefits Administration to be the legal equivalent.
VI .Disabled dependent child
The dependent child must be on the state plan coverage before turning 26 and the Certificate of Incapacitation for Dependent Child form must be submitted prior to the dependent’s 26th birthday.
The insurance carrier will review the certificate of incapacitation form, and if approved for incapacity, the child will continue in the same coverage.
Please review the Dependent Eligibility Definitions and Required Documents flyer for a complete list of the types of dependents who are eligible and the required documentation.