Dependent Eligibility Verification
Verification Schedule
Your family members' eligibility will be verified once every three years. The verification cycle is based on your birth month. The following chart illustrates the schedule.
|
Year of Verification |
2025 |
2026 |
2027 |
|---|---|---|---|
|
Subscriber Birth Month |
February May August November |
March June September December |
January April July October |
How to Verify Dependents?
-
Submit your Dependent Verification Affidavit via Adobe Sign.
-
Submit Supporting Documents (marriage certificate, birth certificate, etc.) via PolyDoc.
What Documents are Required?
Spouse/Domestic Partner
-
Marriage Certificate or Declaration of Domestic Partnership
-
A copy of the first page (1040) of an income tax return from the previous tax year listing the employee and the spouse or domestic partner, or a household bill, account statement, or insurance policy listing the name and address of the employee and the spouse or domestic partner within the last 60 calendar days
Children (Natural Born, Adopted, and Domestic Partner Children)
-
A copy of birth certificate naming the employee as the parent