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 a marriage certificate is needed for proof of eligibility
II. Natural (biological) child under age 26
- The child’s birth certificate (will accept mother’s copy 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 26 placed for guardianship, custody or conservatorship with the head of contract* (placement order active or expired due to age of majority)
Valid order by a court of competent jurisdiction (placement order) establishing guardianship,
custody or conservatorship arrangement between child and head of contract; and an
attestation signed by the head of contract upon initial enrollment and upon request
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
Certificate of Incapacitation for Dependent Child form must be submitted prior to the dependent’s 26th birthday.
*** The insurance carrier will review this form, make a determination and provide Benefits Administration with documentation once a determination has been made. 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.