The PEBB Program’s annual open enrollment is November 1 through 30. Learn more.

Dependent verification

About dependent verification

Dependent verification helps make sure the PEBB Program covers only people who qualify. If you are not enrolled in Medicare Part A and Part B and you want to add dependents to your coverage, you must provide valid verification documents to show they are eligible before they can be enrolled under your coverage.

You must submit all documents in English. Documents written in a foreign language must include a translated copy prepared by a professional translator and be notarized.

Use the list(s) below to determine which verification document(s) you need to submit with your enrollment form(s). If you submit a tax return, you may submit just one copy if it includes all dependents that require verification, such as your spouse and children. Submit the documents along with your enrollment form(s) within the PEBB Program's enrollment timelines. See required forms and timelines for employees, retirees, and Continuation Coverage.

To enroll a spouse

Provide a copy of (choose one):

  • Most recent year’s federal tax return filed jointly that lists the spouse (black out financial information)
  • The most recent year's federal tax return for the subscriber and spouse if filed separately (black out financial information)
  • Marriage certificate and evidence the marriage is still valid (example: a utility bill or a bank statement within the last 2 months showing both the subscriber and spouse's name) (black out financial information)
  • Petition for dissolution of marriage (divorce)
  • Legal separation notice
  • 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 or legal union partner

Include the PEBB Declaration of Tax Status form to indicate whether they qualify as a dependent for tax purposes under IRC Section 125, as modified by IRC Section 105(b).

Provide a copy of (choose one):

  • A certificate/card of state-registered domestic partnership or legal union and evidence the partnership is still valid (example: a utility bill or a bank statement within the last two months showing both the subscriber's and partner's name.) (black out financial information)
  • Petition for invalidity (annulment) of a state-registered domestic partnership or legal union
  • Petition for dissolution of a state-registered domestic partnership or legal union
  • Legal separation notice of a state-registered domestic partnership or legal union
  • Valid J-1 or J-2 visa issued by the U.S. Government

Note: If you encounter delays in getting the marriage certificate within the time allowed, contact your personnel, payroll, or benefits office (employees) or the PEBB Program (retirees/continuation coverage) before your enrollment period ends.

To enroll children

If you are enrolling the child of a state-registered domestic partner, an extended dependent child, or other nonqualified tax dependent, submit the PEBB Declaration of Tax Status form to indicate whether the child qualifies as a dependent for tax purposes under IRC Section 152, as modified by IRC Section 105(b).

If you are enrolling an extended dependent, submit the PEBB Extended Dependent Certification form in addition to the PEBB Declaration of Tax Status form.

Provide a copy of (choose one):

  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter (black out financial information)
    Note: 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*
  • 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 U.S. Government

*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.