|For Spouse||Copy of marriage certificate. If previously married, death certificate or divorce decree.|
|For Removal of Spouse/Child||None at Open Enrollment. Court decree within 31 days of decree during the contract year.|
|For Natural Child(ren)||Child’s birth certificate (showing the parent-child relationship to employee/retiree and/or spouse).|
|For Adopted Child(ren)||Placement papers signed by the courts.|
|For Disabled Child
(26 years and older)
|Physician verification of permanent disability.|
|Foreign Adoptions||Adoption papers signed by the courts; visa showing date of entry to United States.|
|For Stepchild(ren)||Child’s birth certificate (showing parent-child relationship with employee/retiree’s spouse); copy of marriage certificate.|
|For Court-Ordered Support||State affidavit; copy of signed court order requiring employee/retiree to provide support for health coverage.|
|For Guardianship||Court-ordered guardianship deemed permanent for insurance purposes.|
|For Domestic Partner||City of Atlanta Affidavit of Financial Reliance (notarized) within 31 days of approval.|
|For Termination of Domestic Partner||None at Open Enrollment; City of Atlanta Notice of Termination within 31 days of termination during the contract year.|
Social Security number and date of birth must be provided for all dependents. Failure to submit the dependent’s Social Security number will result in termination/denial of coverage (exceptions: newborns age six months or less).
Documentation also applies to life insurance coverage.
No documentation is required at Open Enrollment to delete a dependent.
All documentation should contain the employee’s name and Social Security number.