Verify and enroll my dependents

What is dependent verification?

"Dependent verification" is the process that requires you to verify that your dependents are your dependents. This process ensures that the PEBB Program only covers people who qualify.

There are two exceptions:

• Extended dependent children are reviewed through a separate process. For details, download the PEBB Extended Dependent Certification.
• Dependents previously verified by the School Employees Benefits Board (SEBB) Program. This verification may be used when a subscriber and their dependent moves from SEBB Program coverage to PEBB Program coverage.

We will not enroll a dependent if we cannot verify their eligibility. We reserve the right to review eligibility at any time.

When do I need to provide verification documents?

All subscribers need to provide verification documents when enrolling a spouse, state registered domestic partner, and children.

What are valid dependent verification documents?

Birth certificates, adoption decrees, tax returns, and court ordered parenting plans are among the types of documents you can use to prove eligibility.

All documents must be submitted in English. Documents written in a foreign language must include a translated copy prepared by a professional translator and certified with a notary public seal.

To enroll a spouse

Along with your enrollment forms, provide a copy of (choose one):

• The most recent year's federal tax return (black out financial information), either:
  • A single return that lists your spouse if you filed jointly.
  • Each return for you and your spouse if filed separately.
• A marriage certificate and proof that the marriage is still valid (you do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement, within the last six months showing both your and your spouse's name (black out any financial information). If within six months of marriage, only the certificate is required. Separate utility bills with the same address showing both your and your spouse's name on it.
• Petition for dissolution, petition for legal separation, or petition to invalidate (annul) marriage. Must be filed within the last six months.
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-1 or J-2 visa issued by the U.S. Government

To enroll a state-registered domestic partner

Along with your enrollment forms and the PEBB Declaration of Tax Status (to indicate whether they qualify as a dependent for tax purposes), provide a copy of (choose one):

• Certificate/card of a state-registered domestic partnership or a legal union and proof the partnership is still valid (you do not have to live together), such as a utility bill, life insurance beneficiary document, or bank statement dated within the last six months showing both your and your partner's name (black out any financial information). If within six months of state registration, only the card is required. Separate utility bills with the same address showing both your and your partner's name on it.
• Petition to invalidate (annul) (recently filed, within the last six months) a state-registered domestic partnership.

If you are enrolling a partner of a legal union also provide:

• Proof of Washington State residency for both you and your partner.

Additional dependent verification documents will be required within one year of the partner's enrollment for them to remain enrolled. More information can be found in PEBB Program Administrative Policy 33-1.

To enroll children

Along with your enrollment forms, provide a copy of a (choose one):

• The most recent year's federal tax return that includes the child as a dependent (black out financial information)
  You can submit one copy of your tax return if it includes all family members that require verification.
• Birth certificate (or hospital certificate with the child's footprints on it) showing the name of the parent who is the subscriber, the subscriber's spouse, or the subscriber's state-registered domestic partner.
  If the dependent is the subscriber's stepchild, the subscriber must also verify the spouse or state-registered domestic partner in order to enroll the child, even if not enrolling the spouse or state-registered domestic partner in PEBB insurance coverage.
• Certificate or decree of adoption showing the name of the parent who is the subscriber, the subscriber's spouse, or the subscriber's state-registered domestic partner
• Court-ordered parenting plan
• National Medical Support Notice
• Defense Enrollment Eligibility Reporting System (DEERS) registration
• Valid J-2 visa issued by the U.S. Government

Additional forms you may need

If you are enrolling the child of a state-registered domestic partner or other nonqualified tax dependent, also submit the following form:

• PEBB Declaration of Tax Status (to indicate they qualify as a dependent for tax purposes)

If you are enrolling an extended dependent, also submit the following forms:

• PEBB Declaration of Tax Status (to indicate they qualify as a dependent for tax purposes)
• PEBB Extended Dependent Certification

If you are enrolling a dependent child age 26 or older with a disability, also submit the following form:

• PEBB Certification of a Child with a Disability.

How do I submit verification documents?

You can upload your documents in Benefits 24/7 under the "Document upload" section, or submit your documents using one of the options below.

Employees

Provide documentation directly to your payroll or benefits office.

Retirees and PEBB Continuation Coverage subscribers

Provide documentation to the PEBB Program.

By mail

Washington State Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684

By fax

360-725-0771

Electronically

Send us a secure message through HCA Support, a secure website that allows you to log into your own account to communicate with us. Sign and date any forms you attach to a secure message.

To keep your personal information secure, you will need to set up a SecureAccess Washington (SAW) account to use this option (if you don't already have one) to submit your materials using this method.