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Dependent definition in H&W plan

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Guest Benefit Specialist

We have a letter w/a form that we send when it's a newborn.

Enclosed you will find a “Change in Family Status Election Form” and a form entitled “Proof of Dependency.” The Proof of Dependency Form is used in cases where there has not been legal custody or legal guardianship granted to the employee who is the child’s grandparent.

Please read this form which basically requires providing documentation. Since the child is a newborn and you won’t have any type of documentation at this time, please complete the form and supply a copy of the birth certificate and page 1 of your tax return when received and completed.

Since you are enrolling a new dependent at this time, please indicate any other changes you may wish to make on the enclosed “Change in Family Status Election Form.”

If you have any questions, please call.


I request that my grandchild, _____________________ be added to my group medical coverage provided through my employment with XXXXXXXXXXX Corp.

______________________ is my dependent, residing in my home and is fully supported by me. I have enclosed or will provide upon receipt a copy of the child’s birth certificate and proof of address.

***I will supply the plan administrator with a copy of page 1 of my tax return claiming this child as my dependent. I further understand that failure to provide timely proof that this child meets the eligibility requirements will result in termination of this dependent coverage as taxable compensation to me. To the extent that XXXXXXXXX Corp incurs any costs in connection with the child’s failing to qualify as my dependent, I authorize XXXXXXXXXX Corp to withhold the amount of such costs from my paychecks.

______________________________________________________ _____________________

Employee Signature Date

______________________________________________________ _____________________

Witness Date

On this date ___________________ the above, personally appeared.

Sworn to and subscribed before me this _____________ day of

____________ 20 _____.



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  • 3 weeks later...

It will depend at least partially on the definition of dependent in the Plan Document. Usually, the larger the employer and whether or not self insured (self insured usually have greater latitude in plan design with the carrier/TPA), you will see an increase in leniency in what is allowed as a "dependent", which also includes same sex partners, etc.

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