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 |
帝王会所 Domestic Partner Enrollment Form [PDF] 帝王会所 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 Copy of court order naming you or your spouse/partner Copy of court order of adoption or adoption certificate Copy of a tax return containing the child's social security |
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 | |
Domestic Partnership Starts |
帝王会所 Domestic Partner Enrollment Form [PDF] 帝王会所 Domestic Partner Affidavit [PDF] Supporting documentation as required by Domestic Partner |
Employee Gains Other Coverage |
Proof of other coverage |
Employee Loses Other Coverage |
Proof of coverage loss |
Marriage |
Marriage Certificate |