LCS requires documentation demonstrating all insured dependents meet the eligibility criteria. You have 31 calendar days from your hire/re-hire date (or date of qualifying event) to submit your benefits enrollment form (link) and applicable documentation before coverage becomes effective.

Dependent   Eligibility Definition   Documentation Required

Spouse

 

A person to whom you are legally married.

 

Photocopy of the front page of the employee’s most recent federal tax (Form 1040) return that includes the employee’s spouse (you may remove all financial information and SSNs with the exception of the last four digits)
*Note: not required if married in same year as being added to plan

OR 

Photocopy of marriage certificate or license.

Biological Child/ Stepchild*

 

A biological son or daughter/
stepson or stepdaughter of the employee.

 

Photocopy of birth certificate showing the employee or spouse’s name as mother or father.

If adding a stepchild, must also provide a photocopy of marriage certificate showing the employee and child’s parent’s name and a copy of your most recent federal tax return.

Adopted Child*

 

An adopted son or daughter of the employee or a child placed for adoption.

 

Photocopy of an Adoption Final Decree or an Interlocutory Decree of Adoption with the presiding judge’s signature and seal; 

OR

Photocopy of the child’s birth certificate showing the employee as the adopting parent.

Child under Legal Guardianship*

 

A child for whom the employee has been appointed legal guardian.

 

Photocopy of the final court order, with the presiding judge’s signature and seal, affirming the employee as the child’s legal guardian.

Child under Legal Custody*

 

A child for whom the employee has been granted legal custody.

 

Photocopy of the court order of custody with the presiding judge’s signature and date, affirming the child’s placement in legal custody of the named employee.

Foster Child*

 

Certain eligible foster children.

 

Photocopy of the certified foster care documents with the name of the child and the name of the employee.

Disabled
Child

 

A child age 26 or older who is wholly dependent on the employee for support and maintenance due to a disability that occurred prior to age 26.

 

Photocopy of birth certificate showing employee’s name as mother or father (this only verifies dependent eligibility – your health carrier determines the disability status of the child)

AND

Completed Disability Certification form(s) submitted directly to health carriers.

*Children must be under age 26, unless disabled.

Examples of ineligible individuals include:

  • A former spouse
  • A former spouse’s child, not biologically related to you (exceptions may apply with applicable court orders)
  • A child age 26 or older unless they are disabled and dependent on you for support as defined above

Copies of the above documentation can typically be obtained in the locality where the birth or marriage occurred, or via the websites below. Fees will likely apply.

Copies of the above documentation can typically be obtained in the locality where the birth or marriage occurred, or via the websites below. Fees will likely apply.