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SDSURF › Human Resources › Benefits › Health Plans › List of Documents You May Use to Prove Dependent Eligibility

List of Documents You May Use to Prove Dependent Eligibility

You need to provide a COPY of only one document type under the appropriate "proof" category.


Proof of Marital Status

  1. Your most recent Tax Return: Federal or State, page one only; financial information and the first 5 digits of Social Security numbers can be blacked out. The form must show "married filing jointly" or "married filing separately" with spouse's name indicated, or
  2. If you were married during the current calendar year, use a copy of your marriage certificate, or
  3. Marriage certificate AND proof of joint ownership (within last 12 months):
    • Mortgage statement, or
    • Credit card statement, or
    • Bank statement, or
    • Utility bill, or
    • Rental/lease agreement
  4. If your marriage license or certificate is in a language other than English, please obtain a translation and provide both documents.

Proof of Domestic Partnership

  1. A copy of the Registration of your registered domestic partnership, or
  2. Proof of financial interdependence, provide any three of the following that were issued within last 12 months:
    • Copy of your and your domestic partner's driver's license showing your current address
    • Joint mortgage or joint tenancy on a residential lease
    • Bank account in both names, or
    • Credit card in both names, or
    • Power of attorney for health care, or
    • Designation of each other as authorized signatures on safe deposit boxes, or
    • Joint wills

Proof of Parent/Child Relationship

  1. Birth certificate/hospital record showing the child's parent(s), or
  2. Court-approved adoption papers (with signature or seal), or
  3. Court-approved letters of guardianship (with signature or seal), or
  4. Adoption Placement Agreement and Petition for Adoption, or
  5. Court child support order that shows the child's parent(s)

Proof of Residency

  1. Your most recent Tax Return showing the child listed as a dependent, page one only, financial information and the first 5 digits of Social Security numbers can be blacked out. The number of children who lived with you must agree with the number of dependents you list on the return. If these do not agree, this document is not acceptable proof of residency, or
  2. Child's drivers' licenses or state ID, or
  3. Report card, school registration, or emergency contact form (showing address), or
  4. Social security card stub showing child's name and your address

Proof of Financial Dependency

  1. Your most recent Tax Return Federal or State, showing the children as a dependent, Federal or State, page one only; financial information and the first 5 digits of Social Security numbers can be blacked out, or
  2. Spouse's most recent Tax Return, if child is claimed on spouse's return, Federal or State, page one only; financial information and the first 5 digits of Social Security numbers can be blacked out, or
  3. Divorce decree or court orders showing your responsibilities, or
  4. Canceled checks showing consistent (at least eight months) pattern of support

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