If your dependents meet the eligibility criteria, the first page of your tax returns from the last two years may be the . Dependent Eligibility Verification Matrix Review this chart to confirm that your dependents meet the eligibility criteria and that you have the required documents to verify their eligibility. Government Code section 22843.1 mandates re-verifying the eligibility of your family members. It should also not be a way to remove eligible dependents because an employee makes a mistake in completing a verification process. Audit firms typically have a one-dimensional approach to the dependent eligibility verification process. The re-verification period is based on the employee's birth month. If you will be enrolling dependents in the Novant Health medical plan, you have 31-days to enroll and submit required documentation as noted below: Copy of marriage certificate AND proof of joint debt/ownership. Dependent Verification Checklist Below is a list of eligibility rules and documents required to verify your dependent(s). Login Name Password. Mail or hand-deliver: 1400 McCormick Drive, Suite 110, Largo, MD 20774. You have the option of having your eligibility documents reviewed through an appeal process. If you are a new employee, we strongly encourage you to bring the required documentation to the New Employee Orientation. Dependent Definitions Individuals who are NOT eligible for University of Colorado Medicine benefits include, but are not limited to, the employeeʹs or spouse/Civil Union Partner/Domestic partner's: parents, grandparents, great‐grandparents, siblings, nieces and nephews, aunts and uncles, cousins, grandchildren, great‐grandchildren ,ex‐spouses, civil union ex‐partners, domestic ex . Q: Why is the County requiring documents that were required at the start of employment? Attach this page to the required documents and fax to 303.860.4299. Dependent Verification Form. Complete the Dependent Verification Cover Form and send a copy of the required documentation: Email: Benefits@co.pg.md.us. Dependent Verification Documents. Employee Name: Employee #: I wish to add or drop the listed dependents from the following plans: ☐ . With an average ROI of 10:1, Dependent Eligibility Verification should be a staple of any cost containment strategy. As communicated in the Summary Plan Document and previous Open Enrollment materials, the State Health Benefit Plan (SHBP) has implemented a Dependent Eligibility Verification. A notice was mailed to your home address outlining the steps Our Expert Audit combines three key components: an online affidavit, a verification document review, and a data capture system. EMPLOYEE INFORMATION Name (Last / Jr-Sr., First) Employee ID # Please provide your contact information . Per OEBB Administrative Rules (OAR 111-080-0055), OEBB must complete a Dependent Eligibility Verification (DEV) review for each participating entity at least once every five years. Verifying eligibility helps UofL to ensure compliance with the health plan provision, and manage the increasing costs of health care. if you complete and submit the affidavit of dependent eligibility form, with written evidence of the child's incapacity, within 31 days of the later of the child's 26th birthday or your effective . Include your NAME on all submitted documents in the upper left hand corner. Dependent Eligibility Verification. partner indefinitely. Please note, as Conduent is the administrator for dependent eligibility verification, the HR Service Center will be unable to answer questions . another domestic partner relationship. The results far surpassed our initial expectations. You will be notified by email when documentation for a newly added dependent is required. Dependent Verification Requirements. and Social Security number. Additionally, a Permanent Resident Card with a USCIS-issued sticker extending its validity is a List A document and acceptable for Form I-9. Dependent Verification ID: 9897105 DEPENDENT VERIFICATION NOTIFICATION You currently have enrolled dependent(s) in the Kentucky Employees' Health Plan (KEHP). 2024. A signature is not required for the card to be valid for Form I-9, Employment Eligibility Verification. The verification form is to be submitted together with copies of all required documents to HMS. DEPENDENT ELIGIBILITY Definitions and Required Documents Revised 11/21 *Head of contract is the person who elects coverage and has authority to change coverage elections. Dependent Definitions Individuals who are NOT eligible for University of Colorado Medicine benefits include, but are not limited to, the employeeʹs or spouse/Civil Union Partner/Domestic partner's: parents, grandparents, great‐grandparents, siblings, nieces and nephews, aunts and uncles, cousins, grandchildren, great‐grandchildren ,ex‐spouses, civil union ex‐partners, domestic ex . documents submitted is found to be inaccurate or fraudulent, and that a review of eligibility can occur at any time. Employee Name: Employee #: I wish to add or drop the listed dependents from the following plans: ☐ . Write 'NOT FOR OFFICIAL USE' and BLACK OUT all social security numbers or income information on all documents. When an employee is appointed by another state department, proper retention of these documents enables the personnel office in . Assurant and Mercer Partner to Conduct the Dependent Eligibility Verification. Include your NAME on all submitted documents in the upper left hand corner. 11. Students, in dependent status, who are selected for verification must submit this form and other information to verify the data that they provided on the Free Application for Federal Student Aid ( FAFSA ). It should not be an accusation of anyone or a punishment process for an employee who unknowingly adds an ineligible dependent to a plan. Eligible dependents include but are not limited to: Your spouse ; Children (biological, adopted, and stepchildren) up to the end of the month in which they turn 26. . Medical coverage and dependents. Click the Dependent Eligibility tile, and complete the form; Paper form. The additional information below describes what documentation will be considered valid for the purpose of this verification. 3 DEPENDENT ELIGIBILITY VERIFICATION PROGRAM SUBMISSION CHECKLIST Submit all documents listed as REQUIRED DOCUMENTS on page 2. . Dependent eligibility verification is a process that ensures eligible spouse/partners and children qualify for benefits coverage. My employer conducted dependent verification within the past several years. Forgot User ID? I retained copies of the employee's health, dental, and/or vision enrollment form(s) and all supporting dependent eligibility verification documents in the employee's Official Personnel File. . What are valid dependent verification documents? Dependent coverage will terminate the first day of the month following Total Compensation's receipt of this form. These documents should never be purged from the employee's OPF. The enrollee may remove personal financial information and Social Security Numbers before submission, and non-English documents must be accompanied by a translation. A: All active employees with dependents enrolled in a medical, dental and/or vision plan will be required to provide supporting documents to substantiate dependent eligibility. Surviving dependents eligibility. Your dependent is eligible for coverage as a partner if. 1. Review the required documents below for verifying the eligibility of our dependents and review the definitions. The Verification Process. Please send by secure email only. The Division of State Group Insurance (DSGI) is requesting documents as part of a monthly quality assurance review to confirm that an enrollee's dependent(s)—newly added and existing—are eligible for insurance coverage. A: Any benefit-eligible employee who is covering one or more dependents on the medical plan will be In order for you to add family members (eligible dependents) to your benefit plans, you must submit verification documents. • Intending to remain each other's sole domestic. The following table presents a list of documents that may establish family member eligibility for FEHB coverage. 3 DEPENDENT ELIGIBILITY VERIFICATION PROGRAM SUBMISSION CHECKLIST Submit all documents listed as REQUIRED DOCUMENTS on page 2. If you add family members to your coverage, you are required to provide documentation to verify coverage eligibility for the dependents that you add during the Open Enrollment process or for a qualifying life event. When you enroll online, you must also submit dependent eligibility veri­fication. • You will be able to check the status of your submission and eligibility status of your dependent (s) throughout the process by logging in to this secure site. Dependent's disenrollment takes effect the first of the month after the employee's birth month. Use the check boxes below to indicate the dependent you are verifying and the corresponding required documents you are submitting. . You will need to provide proof-of-eligibility documents directly to ERS. However, for any eligible dependent you elected to cover, you must submit documentation within 60 days of your benefits effective date to verify your dependent's eligibility. When adding a new dependent (spouse, domestic partner, child) to your health and/or dental insurance, you will be required to submit proof of their eligibility. Dependents for whom documentation is required will be listed, and a detailed list of documents required to verify eligibility based on dependent type. 26. The DEV is the process of re-verifying the eligibility of spouses, domestic partners, children, stepchildren, and domestic partner children (family members) enrolled in CalPERS health and/or CSU dental benefit coverage. For almost 20 years, Consova has been the innovator in the healthcare cost containment industry. or. DEPENDENT ELIGIBILITY VERIFICATION COVER SHEET . 2. Here's what you will need to do: As soon as you enroll, start collecting the required documents to verify your dependents' eligibility (see list below). Employees and retirees must send documentation proving that all their dependents newly enrolled in health insurance are eligible for coverage in the Texas Employees Group Benefits Program (GBP). Watch for a verification packet in the mail from Secova within 45 days after you enroll. The Dependent Re-verification (DRV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (family members) enrolled for state health and dental benefits. If you are curious about Customize and create a Dependent Eligibility Verification Program, here are the step-by-step guide you need to follow: Hit the "Get Form" Button on this page. Dependent Eligibility Verification Phase I. If the employee provides verification documents for disenrolled eligible dependents after the verification due date, employer must verify and reenroll the dependent's prospectively for health benefits. If you choose to click the employee portal option, remember to log into your portal before you click the link in the attached document. From Day One, we developed our Customer Support team in-house in the United States to ensure timely results for our clients and their employees. How to Submit Your Documents Fax: 1-866-710-2702 Email: documents@mydependents.com Regular Mail: Dependent Eligibility Center Impact Interactive 3245 Peachtree Parkway, Suite D-307 Suwanee, GA 30024 Note: Send in your documents and your completed Document Submission Form that was in the packet sent to your home. A dependent verification review is not a fishing expedition or witch hunt. Dependent Eligibility Verification Form . Birth certificates, adoption decrees, tax returns, and parenting plans are among the types of documents you can use to prove eligibility. The proof of joint debt/ownership must show both the team member and spouse's names and be dated . For each kind of dependent, there is type of documentation . 10. Testimonials. 3. They just collect proof documents. Below it is broken up by type of dependent and what documents you will need to have a copy to upload to your "Verify Dependents" link in Employee Self Service. Appeals must be in writing and directed to: Trenton, NJ 08625-0299. Any questions concerning the dependent audit should be directed to the SPD Benefits Hotline at 317-232-1167 or toll-free at 877-248-0007. The Dependent Eligibility Verification Checklist . dependents that they must verify eligibility for, the process to submit this information and the deadline. By my signature on this form, I certify and warrant that all information in this dependent eligibility verification document submission is true, correct and current as of the date signed. You may have to request official documents, if you do not have originals. . The DEV process was authorized by Senate Bill (SB) 98 creating Government Code (GC) 22843.1. Verification is a Federal process used to confirm students' eligibility for certain aid programs. Fax: 301-883-6192. The administrative arm of the State of Florida government. Employees are only required to submit one completed . Please read carefully. Certification of report of birth issued by the U.S. Department of State (Forms DS-1350, FS-545, FS-240) Original or certified copy of a birth certificate issued by a state, county, municipal authority or outlying territory of the United States bearing an . This could include a government issued marriage certificate, birth certificate, and adoption certificate or Legal adoption placement document. Attn: Dependent Audit. If you have any questions regarding the dependent eligibility verification process, please contact Conduent HR Services at 1-877-905-3326, Monday through Friday from 7:00 a.m. - 7:00 p.m. (CST). If you die, your dependents (a spouse, state-registered domestic partner, or dependent child) will lose their eligibility toward PEBB . Documents written in a foreign language must include a translated copy prepared by a professional translator and . Appeals must include a cover letter with the full . After a dependent is added, proof of eligibility . USCIS began issuing the current card on May 1, 2017. your relationship to the dependent you believe is eligible. You can prove dependent status by submitting the documents outlined in the materials you receive as part of the audit process. You have 365 days from Dependent Eligibility Verification (DEV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (dependents) enrolled in health and/or dental benefits. Dependent Eligibility Verification (DEV) is a "snap-shot" eligibility review service aimed at helping employers to confirm health plan eligibility for dependents already on their health plan. The long form birth certificate is required because it actually provides not only the name and the birth date of the dependent; it also provides the parents' names, which verifies they are the biological parents. Please, verify the eligibility of your dependents by the deadline in the letter Mercer recently mailed to your home. The Dependent Verification Center -833at 1-372-8748 can provide telephone numbers to state, county, and consulate offices to obtain documents. To add a dependent, contact Retiree Health Care Connect (RHCC) (866-637-7555). 2022. documenting the event and proof of the date you or your dependent changed your county of permanent residence is required Return from Family and Medical Leave (FMLA) Refer to chart on page 3 for additional requirements for adding a dependent. Wait in a petient way for the upload of your Dependent Eligibility Verification Program. A: HISD has partnered with Automatic Data Processing, Inc. (ADP) to conduct the dependent eligibility verification process. Other . Employees are to promptly provide re-verification documents and a completed Dependent Eligibility Verification Checklist (CalHR Form 781) to their departmental personnel office. Q: What is Dependent Eligibility Verification? If the dependent is now eligible for coverage, yes, you can enroll him or her during your enrollment period or within 31 days of a qualifying life event (QLE). Assurant has engaged Mercer to manage this verification process. Ensure each document is a LEGIBLE BLACK and WHITE COPY of the original document. The information below is intended to assist entities plan for these reviews. All documents must be unexpired. Q: Will I be required to complete the verification process? To enroll your family members in Texas A&M University System group insurance plans you must add dependents in Workday and provide dependent verification documents to prove eligibility. (CalPERS Form HBD-12) and the supporting documentation used to substantiate dependent eligibility. A: The County requires that all employees submit documents to verify their eligible dependents upon hire and if you experience a qualifying life event during your career. 2023. Please contact us at (877) 275-4377 for additional information. A dependent who does not meet the eligibility requirements will be removed from . All documents must be submitted in English. To ensure accountability in the State Group Insurance program, effective July 1, 2020, the People First Service Center will be requesting documents as part of the Dependent Eligibility Verification process to confirm that an employee's newly added dependents are eligible for insurance coverage. Expert Audit® Dependent Eligibility Verification. Save $3,000 - 3,500 per plan member per year when you complete a dependent eligibility audit with benefitexpress. During the DEV process, our verification team will collect documents that confirm dependent eligibility, which allows employers to identify any . You must check the "Remove" box on the Dependent Verification Form for each dependent who does not currently meet the eligibility requirements. Q: Who will be included in the verification? This will result in a gap of benefit coverage. Is it common for employers to verify eligibility of dependents for benefits? Dependent verification helps ensure that Texas A&M only covers people who qualify for coverage so we spend taxpayer dollars . LIST C: Documents That Establish Employment Authorization. If you are asked to participate in a dependent eligibility audit, you will be required to submit proof that everyone covered as a dependent under your employer's plan is your legal dependent. This process requires documentation to verify coverage eligibility for the dependent(s) listed on the reverse side of this letter. Dependent Verification Center. The following chart illustrates the current schedule: 2021. Re-verification Cycles. Any employee who adds a dependent to his or her Penn State medical, dental, vision and/or tuition benefit coverage will be required to provide documentation which demonstrates that the individual meets Penn State's eligibility criteria for the benefit being selected. Our easy to use, customizable website informs your employees of requirements, tracks progress and provides the ability to upload dependent verification documents via mobile device. Indianapolis, IN 46204. DEPENDENT ELIGIBILITY VERIFICATION (DEV) FREQUENTLY ASKED QUESTIONS CONTACT INFORMATION FOR HEALTH MANAGEMENT SYSTEMS (HMS) AuditOS.com: Website for information and to upload verification form and documents (866) 365-7285: Call Center for questions and assistance from 5 a.m. to 8 p.m. PT, Monday-Friday (877) 223-8478: Fax number to send verification form and documents To understand which documents are required to prove dependent eligibility, please review each document listed next to the dependent(s) relationship on your Documentation Checklist mailed to you by Consova. The Dependent Re-verification (DRV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (family members) enrolled for CalPERS health and CSU dental benefits. Alternatively, you may . Verification Documents. over. ID Dependent Type Age Eligibility Requirements LS •Legal Spouse N/A The covered participant's husband or wife If you are unable to complete the Dependent Eligibility Verification in your employee portal, a paperform can be downloaded below. Never send original documents. Why is another audit being conducted so soon? We help employers conduct . Fax: 317-232-3011. (including social security numbers or qualified alternate identification) to the Employee Solutions Center. Departmental personnel staff may use the notification templates provided in the Dependent Re-Verification Toolkit. Dependent Eligibility Verification Form . Dependent Eligibility Verification Process. Beginning in 2018, the eligibility of dependents enrolled in state-sponsored health and dental benefits will be re-verified once every three years. 92.1%. Please mark out or black out any Social Security numbers and any personal financial information on the copies of your documents BEFORE you . We achieved an incredible ROI on the dependent eligibility verification solution, which grabbed the attention of the Sr. Management Team and Board of Directors. This confirms the dependent is eligible for . This table lists the documents that will be accepted as proof of eligibility for dependents. conduct a full dependent verification audit. Dependent Eligibility Verification (DEV) Review. Email: deva@spd.in.gov. A: Dependent eligibility verification is a process that confirms covered dependents meet an insurance plan's eligibility requirements. As a result, you must submit documentation to the Dependent Verification Center to verify your dependent's eligibility. A dependent verification audit is a process used by organizations to confirm that all dependents enrolled in a group benefit plan are eligible for coverage. Members may appeal a termination if they comply with the audit and provide proof of a dependent (s)' eligibility by submitting the required documentation to the Health Benefits Bureau of the Division of Pensions and Benefits. What happens to the coverage of a dependent enrolled in benefits who does not meet the eligibility requirements? If you provide re-verification documents for dis-enrolled, eligible dependents after the first day of . The below list is acceptable documentation for the dependent verification program. TriHealth has engaged Mercer to manage this verification process. This process applies to new hires, marriages . In Mercer's experience providing dependent eligibility verification services, we have found the average annual incurred medical cost per dependent exceeds $4570 with 3% - 10% dependents removed. • Not legally married to another person or part of. Most employers have a fiduciary responsibility to ensure that their plans operate according to the terms in the plan documents, including . Return from Leave of Absence Refer to chart on page 3 for additional requirements for adding a dependent. Dependent verification audits require employees to provide documentation to validate the relationship between the employee and the dependent. Family Member Acceptable Document(s) to Verify Eligibility if you complete and submit the affidavit of dependent eligibility form, with written evidence of the child's incapacity, within 31 days of the later of the child's 26th birthday or your effective . Required documentation for dependents listed on your verification letter must be received by HMS NO LATER than AUGUST 19, 2016. Dependent verification is a time-sensitive, information-intensive undertaking that requires attention to detail and clear communication. Submit copies (with employee name . As part of the continued efforts of Assurant to offer affordable health care coverage and to ensure compliance with federal regulations, you are required to verify the eligibility of your dependent (s). In most cases at least TWO forms of documentation are required for dependents. You will need to provide the dependent's date of birth, date of the event (such as marriage, birth or adoption, court order/Qualified Medical Child Support Order (QMCSO), etc.) On average, 5-8% percent of enrolled dependents are found to be ineligible for coverage, resulting in immediate and meaningful cost savings. The numbers speak volumes. As part of the dependent verification process, Alight Solutions. • Intending to reside together in the same. In addition to dependent verification documents (if required), also submit the appropriate enrollment/change form and the PEBB Certification of a Child with a Disability form. Sign, date and submit this document If you have questions, call the OHR Contact Center at 612-624-8647 or 1-800-756-2363 Option 1 for Benefits, or by email at benefits@umn.edu. 2. Please go to Employee Self Service and locate the Verify Dependents link. 402 W Washington St. RM W-161. securely destroys all documents, after the process is completed. you and your partner are: • At least age 18. To ensure only eligible dependents are enrolled in employer-sponsored health benefits, Government Code section . With over 1,000 verifications completed and over $1B in . We have a better way. Documents must be uploaded through the oceaneer.life/hr portal. Ensure each document is a LEGIBLE BLACK and WHITE COPY of the original document. Write 'NOT FOR OFFICIAL USE' and BLACK OUT all social security numbers or income information on all documents. The Guide of editing Dependent Eligibility Verification Program Online.

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