Document Requirements
The information below describes what documentation will be considered valid for the purpose of this verification. To review specific documents required to prove your dependent's eligibility, please review document requirements in your secure portal.
Spouse
Plan Definition
- - Your legally married spouse (Common-law, legally separated or divorced spouses are not eligible for coverage)
Document Requirements
- A copy of your marriage certificate
AND
-
A copy of page one through the claimed dependents section of your jointly filed federal tax return (form 1040) or both of your tax returns if you file separately, from the most recent tax season. If married in the current calendar year, only the marriage certificate will be required. Please black out the first five digits of any Social Security Numbers.
AND
Completion and return of the Benefit Verification Form, if required. This form can be found online at https://iverify.consova.com
Working Spouse Rule
If your spouse is offered coverage through their own employer but chooses to remain enrolled in the LifeBridge Health medical plan you will incur a $30/per pay period surcharge.
Domestic Partner
Children age 26 and under
Plan Definition
- Your natural child, legally adopted child, or child in the process of being adopted;
- Your stepchild;
- A child of whom you have full legal guardianship of;
- A child who is the subject of a Qualified Medical Child Support Order (QMCSO) issued to you.
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 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 a copy of page one through the claimed dependents section of your jointly filed federal tax return (form 1040) or both of your tax returns if you file separately, from the most recent tax season. Please black out the first five digits of any Social Security numbers.
- - Child whom you have full legal guardianship: Signed Court Order and a copy of page one through the claimed dependents section of your filed federal tax return (form 1040) from the most recent tax season claiming the child as a dependent. Please black out the first five digits of any Social Security numbers.
- - A child who is the subject of a Qualified Medical Child Support Order (QMCSO): Signed Court Order.
Dental dependents over age 19 will be required to provide documentation establishing they are enrolled in an accredited college/university as a full-time student (12 credit hours minimum)
Please note: For unmarried disabled children, age 26 or over, in addition to the birth certificate, we will also need a copy of page one through the claimed dependents section of your filed federal tax return (form 1040) from the most recent tax season claiming the child as a dependent. Please black out the first five digits of any Social Security numbers.
Medical coverage for children reaching the age of 26 ends on the month which they turn 26.
Dental coverage for children reaching the age of 19 ends the last day of the month in which they turn 19 unless they are a full time student in which case they are eligible until age 23
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