VERIFICATION OF DEPENDENT ELIGIBILITY REQUIREMENTS

For each applicable Dependent enrolled, the plan member shall submit the following information. If a dependent is enrolled due to a mid-year change qualifying event, additional verification may be required.

spouse

1. A copy of the certified marriage certificate; or

2. A copy of the front page of the most recent tax-return showing the tax filing status as “married”. Any financial information may be blacked out; or

3. A copy of the recorded and notarized Affidavit of Common Law Marriage (available at benefits.mt.gov/forms).

domestic partner

1. Declaration of Domestic Partner Relationship and Affidavit of Shared Residence forms (available at benefits.mt.gov/forms); and

2. A copy of mutually-granted powers of attorney or health care powers of attorney; or

3. A copy of mutual designations of primary beneficiary in will, life insurance policies or retirement plans. Domestic partners are automatically defaulted to a non-qualified tax dependent status.

Dependent children

1. A copy of the Dependent child’s birth certificate, adoption order or pre-adoption papers, or

2. A copy of a court-ordered parenting plan, custody agreement or guardianship order.

stepchildren

1. Required documentation listed above for domestic partner or spouse, if individual is not enrolled; and

2. A copy of the stepchild’s birth certificate, adoption order or pre-adoption papers; or

3. A copy of a court-ordered parenting plan, custody agreement or guardianship order.

incapacitated children

It is the plan members responsibility to provide the required documentation, listed below, to continue State Plan benefits for an incapacitated child(red) over the age of 26. 

1. The incapacity commenced before the date the child’s Plan coverage would otherwise terminate. Eligibility Provisions State of Montana Benefit Plan (State Plan) Document at benefits.mt.gov/forms.  

2. The child is dependent upon the eligible Participant or Retiree for support and maintenance within the current meaning of the COBRA disability continuation criteria. In other words, the Social Security Administration (SSA) must have determined that the child is disabled and qualifies for disability benefits through Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI) (SSA documentation must be provided).

3. Notification, SSA documentation and tax documentation must be submitted to the Plan Administrator within thirty-one (31) days of the date the child’s coverage would otherwise terminate.

4. Must submit the most recent tax return or other documentation which indicates the disabled child is a qualified tax dependent of the Participant or Retiree. Other documentation must show the Participant or Retiree provides more than 50% of the disabled child’s support and maintenance.

5. Re-certification of the disability may be required annually by the Plan.

grandchildren

1. A copy of the grandchild’s adoption order or pre-adoption papers; or

2. A copy of a court-ordered custody agreement or legal guardianship.