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 | 51ยายื Domestic Partner Enrollment Form [PDF] 51ยายื 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
| 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 | 51ยายื Domestic Partner Enrollment Form [PDF] 51ยายื 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 |