The State System requires verification of health care program eligibility both for dependents of newly hired and current employees as a result of a life event change (i.e., marriage, birth or adoption of a child, etc.) or during open enrollment.  This is to ensure that dependents covered under the State System Health Care Programs and the Supplemental Benefits Program meet the eligibility requirements for coverage. 

  • New employees will have 60 days from their date of hire to provide satisfactory documentation.
  • Current employees will have 60 days from the date they add a new dependent as a result of a life event change to provide satisfactory documentation.
  • For dependents added during open enrollment, the required documentation must be provided by the end of the open enrollment period for the dependent’s coverage to be effective.
  • All documentation must be provided to the university human resources office.

If required documentation is not provided within 60 days (or the end of open enrollment), the dependent(s) will be removed from coverage retroactively to the date of their enrollment. COBRA benefits will not be offered as the dependent was not deemed eligible for coverage. If claims were incurred for an ineligible dependent, restitution will be required.

The following chart has been prepared to provide you with types of documentation that are acceptable for dependent verification and possible resources for documentation.  You must provide an original document or a certified copy to your university human resources office when verifying your dependent(s).  The university human resources office will review the documentation provided to determine dependent eligibility.  You will retain the original documents and copies will not be maintained in the human resources office.

Dependent Required Documentation Possible Resources to Obtain Documentation
Spouse

Marriage Certificate (this is not the certificate provided from the official conducting the ceremony)

Spouse Health Care Enrollment Attestation Form (for employees hired on/after July 1, 2013)

Affidavit attesting to the existence of marriage performed outside of the United States if a foreign marriage

County courthouse that issued original marriage certificate or can provide a certified copy. A list of Pennsylvania County Courthouses can be found here .

Spouse Health Care Attestation Form available on the State System website or from the university human resources office

Foreign Marriages Affidavit available from university human resources office
Child(ren) by birth Birth certificate*

For Pennsylvania births, birth certificates are available from the PA Department of Health, Division of Vital Records and can be requested by fax, mail, or online at health.pa.gov.

Many states allow you to order a new birth certificate from their website. Access to other state websites can be linked through http://www.cdc.gov/nchs/w2w.htm
Child(ren) by adoption Court approved adoption order OR Placement letter from court/adoption agency for pending adoptions

County courthouse that issued final adoption order

County court/adoption agency that issued placement letter
Child(ren) by legal guardianship

Court or agency order establishing guardianship AND

Affidavit of Residence and/or Dependency for Other Children Form

County courthouse/agency that issued guardianship order

Affidavit of Residence and/or Dependency for Other Children Form available from university human resources office

Stepchildren

 Birth certificate* AND
Marriage certificate

  • For Pennsylvania births, birth certificates are available from the PA Department of Health, Division of Vital Records and can be requested by fax, mail, or online at health.pa.gov.

  • Many states allow you to order a new birth certificate from their website. Access to other state websites can be linked through http://www.cdc.gov/nchs/w2w.htm

  • County courthouse that issued original marriage certificate. A list of Pennsylvania County Courthouses can be found at www.health.pa.gov under Health Statistics and Vital Records.  
Disabled dependent
 Will be verified by health plan vendor  

Health Plan Vendor

* If document was generated outside of US and is not in English, it must be translated and certified by translator