To enroll eligible dependents in a health plan, you must provide the required verification documents listed below. Please ensure all documents are current and clearly show the requested information.

SPOUSE

Definition: Your legal spouse

Required Documents (provide TWO):

Primary Document (choose one):

A copy of your marriage certificate; OR

Certificate of Informal Marriage

Secondary Document (choose one of the following):

• A copy of the front page of your most current federal tax return confirming this dependent is your spouse.

• A document showing joint ownership status such as a recurring monthly household bill or statement of account. The document must list both of your names and a recent date in the past 60 days.

• A document showing your spouse’s current residency such as a recurring household bill or statement of account. The document must list your spouse’s name, your mailing address, and a recent date in the past 60 days.

⚠ Note: Healthcare bills will not be accepted as proof of eligibility as healthcare coverage is being verified.

CHILD

Definition: Children up to age 26

Eligible dependent children include:

• Your biological children

• Your stepchildren

• Your adopted children (as of the date the child is placed for adoption, which means the assumption and retention of a legal obligation for total or partial support of a child in anticipation of adoption of the child)

• Any children for whom you are responsible under court order

Required Document (provide ONE):

A copy of the child’s birth certificate/hospital birth record or adoption certificate naming you or your spouse/partner as the child’s parent. Please note the document must list the first and last names of the child and parent(s).

OR

A copy of the court order naming you or your spouse/partner as the child’s legal guardian.

Coverage Extension to Age 26+:

Coverage can be extended to children age 26 or older if they are primarily supported by you or your spouse and are incapable of self-sustaining employment by reason of mental or physical disability. The dependent must have become incapable of self-support before age 26.

Special Note for Stepchildren:

If you are covering a stepchild, you must also provide documentation of your current relationship to your spouse as requested in the SPOUSE section above.

Document Submission

Please submit all required documentation to the enrollment site. Ensure copies are clear, legible, and include the information specified above. Incomplete submissions may delay enrollment in benefits coverage.

For questions, please call the Benefits Service Center at 1-844-880-6774.