Required Employment D Documents Document Options for Ve erifying Eligibility Legal S Spouse Eligibility requirements:

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1 Required Employment Documents Below is a list of eligibility rules and documents required to verify the eligibility of each dependent. In some cases, at least TWO forms of documentation aree required. Please read carefully. Document Options for Verifying Eligibility Legal Spouse Your husband or wife under federal law. issued Marriage Certificate and Federal Tax Return within last 2 years listing spouse issued Marriage Certificate and Proof of Joint Ownership issued within last 6 issued Marriage Certificate only (if married within the last 12 ) Domestic Partner Your domestic partner registered with a state that allows for same-sex or opposite sex domestic partner relationships Must be 18 years of age or older Must be capable of consenting to the domestic partnership Must be each other's sole domestic partner in a long-term committed relationship and intend to remain so indefinitely Must share a common residence Must not be related by blood in a way that would prevent you from being married to each other Must be financially interdependent Must not be legally married to someone else or be a member of another domestic partnership Certificate of Domestic Partner Registration and Proof of Joint Ownership issued within last 6 Notarized Affidavit of Domestic Partnership and Proof of Joint Ownership issued within last 6

2 Common Law Spouse Your common law spouse under state law. Notarized Affidavit of Common Law Marriage and Proof of Joint Ownership issued within last 6 Notarized Affidavit of Common Law Marriage and Federal Tax Return issued within last 2 years listing common law spouse Civil Union Partner Your civil union partner under state law. Civil Union Partner Certificate and Proof of Joint Ownership issued within last 6 Biological Child Biological child, up to age 26 issued Birth Certificate (including parents names) Disabled Biological Child Biological child, age 26 and over Must be financially supported by you issued Birth Certificate (including parents names) and Federal Tax Return within last 2 years claiming child Adopted Child Must be your adopted child, up to age 26 Adoption Placement Agreement (including child s date of birth) or Petition for Adoption (including child s date of birth) Adoption Certificate (including child s date of birth)

3 Disabled Adopted Child Must be your adopted child, age 26 and over Must be financially supported by you Document option for verifying eligibility: (provide the following) Adoption Certificate (including child s date of birth) and Federal Tax Return within last 2 years claiming child Step-Child Must be your spouse s child, age 26 and over Certificate, and Federal Tax Return within last 2 years listing spouse issued Birth Certificate (including parents names) and Government issued Marriage Certificate (if married within the last 12 ) Law Marriage, and Proof of Joint Ownership issued within last 6 Law Marriage, and Federal Tax Return within last 2 years listing common law spouse Certificate, and a Proof of Joint Ownership issued within last 6 Disabled Step-Child Must be your spouse's child, age 26 and over Must be financially supported by you and your spouse Certificate, and Federal Tax Return within last 2 years listing spouse & claiming child Law Marriage, Proof of Joint Ownership issued within last 6, and Federal Tax Return Certificate, Proof of Joint Ownership issued within last 6, and Federal Tax Return within last 2 years claiming child Law marriage, and Federal Tax Return within last 2 years Listing Common Law Spouse & claiming child

4 Domestic Partner Child Must be your domestic partner s child, up to age 26 issued Birth Certificate (including parents names), Notarized Affidavit of Domestic Partnership and Proof of Joint Ownership issued within last 6 issued Birth Certificate (including parents names), Certificate of Domestic Partner Registration, and Proof of Joint Ownership issued within last 6 Domestic Partner Disabled Child Must be your domestic partner's child, age 26 and over Must be financially supported by you and your domestic partner issued Birth Certificate (including parents names), Notarized Affidavit of Domestic Partnership, Proof of Joint Ownership issued within last 6, and Federal Tax Return issued Birth Certificate (including parents names), Certificate of Domestic Partner Registration, Proof of Joint Ownership issued within last 6 and Federal Tax Return Civil Union Partner Child Must be your civil union partner s child, up to age 26 issued Birth Certificate (including parents names), Civil Union Partner Certificate, and Proof of Joint Ownership issued within last 6 Civil Union Partner Disabled Child Must be your civil union partner's child, age 26 and over Must be financially supported by you and your civil union partner issued Birth Certificate (including parents names), Civil Union Partner Certificate, Proof of Joint Ownership issued within last 6, and Federal Tax Return within last 2 years claiming child Legal Ward Must be your legal ward as ordered by the court, up to age 26 issued Birth Certificate and Court Ordered Document of Legal Custody

5 Disabled Legal Ward Must be your legal ward as ordered by the court, age 26 and over Must be financially supported by you and your spouse issued Birth Certificate, Court Ordered Document of Legal Custody, and Federal Tax Return Foster Child Must be your foster child, up to age 26 issued Birth Certificate and Foster Care paperwork The above benefit descriptions describe the plan(s) generally, and in summary form only. In the event of a conflict between what is stated in this document and the governing plan document(s), the plan document(s) will control.

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