- Spouse or qualified domestic partner
- Children under age 26, and dependent children of any age who are not able to support themselves due to a physical or mental disability who became disabled before age 26. An eligible child includes your natural child, adopted child, step child or child for whom you have been appointed legal guardianship by a court of law. Children of a covered spouse or domestic partner are also eligible. Newborns must be enrolled within 30 days of birth to be covered.
You are required to have documentation of your dependent’s relationship to you (such as a birth certificate) and must submit all documents to the Home Office Benefits Department.
Call (949) 705-4900
Fax (949) 705-4991
- Natural children
- Birth certificate
- Court order or child support order
- Adoption and legal guardianship
- Submit one of the following:
- A copy of a birth certificate (long form) showing the employee as parent; or
- Court documentation verifying completed adoption of legal guardianship
- Step children
Multiple documentations required:
- Documentation showing the name of the parent/guardian of child and;
- Proof that the parent is the current spouse or domestic partner of the employee (see appropriate requirements)
- Disabled child over the age of 26
Multiple documentations required:
- Proof of relationship based on the appropriate child type (see appropriate requirements)
- Proof from a physician that prior to age twenty-six (26) child was and is incapable of self-support due to a continuously disabling illness or injury
- Silverado Disabled Child Affidavit (additional verification may be required through the health plan provider)
- Legal spouse
- Marriage Certificate of marriage within the last year
- Marriage Certificate AND proof of Current Joint Ownership. Current document dated within the last six (6) months that include the employee’s/retiree’s name, the spouse’s name and current address.
Examples of joint ownership include:
- Mortgage statement or rental/lease agreement (fiscal information crossed out)
- Property tax bill (fiscal information crossed out)
- Joint checking or savings account statement (fiscal information crossed out)
- Domestic partner
- Three Documents Required:
- Silverado Domestic Partner Affidavit (Request from Silverado Home Office Benefits) AND
- If registered domestic partnership, submit Municipal/State domestic partnership registration or civil union license AND one document listed below:
- Common ownership of property (including ownership of an automobile)
- Joint bank/utility bill or credit account statement cover page listing both names
- Driver’s licenses listing a common address
- Assignment of a durable property or health care power of attorney
- If not registered domestic partnership, submit any two (2) of the following:
- Joint ownership of property or a common leasehold interest in property
- Common ownership of an automobile
- Joint bank account statement cover page
- Driver’s license listing a common address
*If the domestic partner resides in a state that provides for registration of domestic partners and they have so registered, provide evidence of such registration.
- Do not send original documents because they will not be returned.
- Birth certificate must list the parent(s) name.
- Only send the first page of your most current Federal Tax Return that shows your spouse (you are encouraged to remove or block out all financial information on the return).
- Marriage Licenses or Certificates must be the final document that includes the date of the marriage.
- Mothers, fathers, grandparents, aunts, uncles, brothers, sisters, grandchildren, nephews, nieces, boyfriends and girlfriends, cousins, etc., are almost never eligible dependents. They would need to meet one of the criteria listed above.
- A former or divorced spouse/domestic partner is not eligible for continued coverage as a dependent under the employee’s benefit programs, even if the court orders the subscriber to provide coverage.
All changes to benefits must be qualified and submitted with appropriate documentation within 30 days of the event. Not doing so could cause delays or prevent a change in coverage completely. In the event that Associates don’t provide this proof coverage could be terminated retroactively back to the date of coverage and Associate will be responsible for any claims incurred during the plan year. It is the Associate’s responsibility to notify Silverado Home Office Benefits Department within 30 days of a change in eligibility of one of their covered dependents.
This is meant to be summary other events may apply or other documents may be requested please reach out with any questions.
If there is a discrepancy between this guide and the official plan documents, the plan documents will govern. You can access the plan documents here or by contacting Home Office Benefits at firstname.lastname@example.org.