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Verification of Dependents & Enrollment

Human Resources requires the following documentation for new hires enrolling dependents in health and welfare benefits. Existing employees will need to furnish documentation if/when making changes to an enrollment choice, such as adding dependents due to a qualifying life event such as marriage.

Required documentation must be submitted to Human Resources within 31 days of date of hire or within 31 days of a qualified status change. Documentation may be uploaded in MPI: Benefits Self Service or by using our . Failure to provide required documentation may result in a denial of coverage for eligible dependents. Failure to submit dependent verification paperwork may result in insurance coverage denial.

Dependent Verification

DEPENDENT REQUIRED DOCUMENTS
Married Spouse

 Marriage certificate

Domestic Partner
 

51社区 Domestic Partner Enrollment Form [PDF]

51社区 Domestic Partner Affidavit [PDF]

Supporting documentation as required by Domestic Partner Affidavit

Children birth to age 25
(Biological, Step, Adopted, Legal Dependent, Domestic Partner Dependents)

Copy of a birth certificate or hospital record naming you
or your spouse/partner as the child's parent, or

Copy of court order naming you or your spouse/partner
as child's legal guardian, or

Copy of court order of adoption or adoption certificate
naming you or your spouse/partner as the child's parent

Copy of a tax return containing the child's social security
number

Enrollment Verification

Dependent Gains Other Coverage

   Proof of other coverage

Dependent Loses Other Coverage

   Proof of coverage loss

Divorce

   Copy of Divorce Decree

Domestic Partnership Ends

  Statement of Termination of Domestic Partnership [PDF]  

Domestic Partnership Starts

  51社区 Domestic Partner Enrollment Form [PDF]

  51社区 Domestic Partner Affidavit [PDF]

  Supporting documentation as required by Domestic Partner
  Affidavit

Employee Gains Other Coverage

   Proof of other coverage

Employee Loses Other Coverage

   Proof of coverage loss

Marriage

   Marriage Certificate