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Eligibility Documentation

The first time you enroll a spouse, domestic partner or child in health, dental, or vision benefits, you must provide Human Resources with certain documents to prove eligibility. The documents below are required for each individual you wish to enroll.


Individual

Eligibility Criteria

Required Documentation

Spouse

Legally Married

Legal marriage certificate or license. By submitting this document, you are attesting that you are currently legally married and are not divorced.

OR

Page 1 of your most recently-filed Income Tax Return indicating your relationship with your spouse.

Domestic Partner

See “Who Is Eligible for Benefits?

Completed Unity Health System Affidavit of Domestic Partnership and related forms

Dependent Children
Under Age 26 for Health and Vision Coverage

Dependent Children
Under Age 23 for Dental Coverage

  • Child by birth or adoption
  • Foster child or child by legal guardianship
  • Stepchild or child of eligible  domestic partner

 

Birth Certificate showing either you, your spouse, or both are the child’s natural parent(s); birth certificate showing your domestic partner is the child’s natural parent
OR
Page 1 of your most recently-filed Income Tax Return indicating your relationship with dependent child.
OR
Certified court-approved adoption/custody/ guardianship papers showing either you, your spouse or your domestic partner are legal parent(s) or guardian(s) of the child

 

Disabled dependent child age 23 (for dental coverage) or 26 (for health/vision coverage) and over

You’ll need to supply one of the documents above to verify status and apply for approval through Excellus, the benefit administrator. Click here for more information.

 

Child covered by a Qualified Medical Child Support Order

Documentation in this situation is provided to Unity by the County. You do not need to provide additional information.