► All active employees (full-time, part-time, intern, etc.) regularly scheduled to work at least 30 hours per week ►Effective 1/1/2024, all active employees (full-time, part-time, intern, etc.) regularly scheduled to work at least 20 hours per week |
► Your spouse or domestic partner |
► Your children, stepchildren, children of your domestic partner or children in your guardianship up to age 26 |
► Adult children, stepchildren, children of your domestic partner or children in your guardianship of any age who are disabled |
*Notes:
If you will be enrolling dependents, remember that dependent verification is required. The good news is that you can now provide the substantiation documentation during your enrollment! Click HERE for the list of documents that satisfy the substantiation requirement. We suggest that you have your documentation available electronically (for example, take a picture of your marriage certificate) so you can upload it as you enroll.
Click HERE for the Domestic Partner Affidavit that can be used to verify the eligibility of your Common Law Spouse or Domestic Partner. A photo of this completed form should be uploaded to the enrollment site.
If you want to remove your Domestic Partner or Common Law Spouse from coverage because the relationship has ended, click HERE for the Affidavit of Termination
of Domestic Partnership. A photo of this completed form should be uploaded to the enrollment site.