Document Requirements
To understand which documents are required to prove dependent eligibility, please review each document listed next to the dependent(s) relationship on your Dependent Documentation Request mailed to you by Consova. The additional information below describes what documentation will be considered valid for the purpose of this verification.
Please note Pennsylvania law prohibits photocopying or photographing birth certificates to prevent a copy from being used as an official record.
If your dependent’s birth certificate was issued by the state of Pennsylvania, please indicate the following on the copy of the birth certificate “This copy was made for insurance purposes only”, to ensure you remain compliant with state law.
You can also request a certified copy of a vital record from the Pennsylvania Department of Health Services in-person, via the mail, and online.
- Each certified copy costs $20. You must pay by check or money order made out to “VITAL RECORDS” for the exact amount of your order. They do not accept credit cards.
- For more information about how to request a certified copy of a vital record, please visit the Pennsylvania Department of Health Services website.
- The certified copy you purchase should be mailed to Consova.
Spouse
Plan Definition
- Your legally married spouse
(divorced spouses are not eligible for coverage)
Document Requirements
- A copy of marriage certificate.
AND
-
A copy of page one through the signature line of your Jointly filed Federal Tax return from the most recent Tax season or both of your Tax returns if you file separately. Please black out the first five digits of any Social Security Numbers and any IRS Identity Protection PIN's.
AND
- The enclosed Spouse/Domestic Partner Surcharge Verification and Information Release Authorization Form (this form is only required if enclosed to verify spousal surcharge exemption).
Domestic Partner
Plan Definition
- Engaged in an ongoing committed and exclusive relationship
- Must be each other’s sole domestic partner
- Both must be at least 18 years of age
- Must reside in the same residence
- Not be related to each other
Document Requirements
- Proof of dependency as evidenced by a copy of two of the following documents:
- Proof of shared residence via joint mortgage statement or rental agreement
- Automobile title or registration showing joint ownership of vehicle
- Joint checking, bank or investment account statement
- Joint credit account statement
- A will and/or life insurance policy which designates the other as primary beneficiary
AND
- The enclosed Spouse/Domestic Partner Verification and Information Release Authorization Form (this form is only required if enclosed to verify spousal surcharge exemption)
- Please note: Proof of dependency documents need to be dated within 60 days prior to the date of this letter and insurance and medical-related documents will not be accepted as a proof of dependency.
Child under the age of 26
Plan Definition
- Your natural child, legally adopted child who is under age 18 at time of adoption, or child under the age of 18 in the process of being adopted;
- Stepchild;
- A child of your Domestic Partner; or
- A child whom you have legal guardianship of; or
- A child who is the subject of a Qualified Medical Child Support Order (QMCSO) issued to you.
- Child with Disabilities
- Unmarried child who is physically or mentally incapable for self-support and whose medical or physical disability commenced before the child reached age 26
Document Requirements
- A copy of the following documents (varies by the relationship of the child to the Employee):
- Natural child or legally adopted child: State or county issued birth certificate showing employee’s name or signed court order. If birth certificate lists employee’s maiden name, please provide marriage certificate.
- Stepchild: State or county issued birth certificate showing parents’ names, copy of your marriage certificate, and copy of your Jointly filed Federal Tax return from the most recent Tax season (front page only).
- Child of your domestic partner: State or county issued birth certificate and proof of established Domestic Partnership.
- Child whom you have legal guardianship: Signed court order and your Tax return from the most recent Tax season claiming the child as a dependent.
- Child who is the subject of a Qualified Medical Child Support Order: Signed court order.
- Please note: for unmarried disabled children aged 26 or over, in addition to the birth certificate, we will also need a copy of your Federal Tax return from the most recent Tax season claiming the child (front page only).
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