Skip to main content
Home
Header - Toolbar - Top
  • In a crisis?
  • Login
    • Apple Health accounts
    • PEBB My Account
    • SEBB My Account
    • ProviderOne
    • HCA employees
    • Remote access for vendors

Breadcrumb

  1. Home
  2. Employee and retiree benefits
  3. Retirees
  4. Verify and enroll my dependents

Verify and enroll my dependents

In most cases, to enroll dependents under your PEBB benefits, you will be required to provide proof they are your dependents. This page helps you find the documents you need to submit to verify and enroll your dependents when you enroll yourself.

On this page

What is dependent verification?

When do I need to provide verification documents?

What are valid dependent verification documents?

How do I submit verification documents?

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?

It depends on your situation.

Employees

When you enroll a dependent.

Retirees

When you enroll a dependent and you are not enrolled in Medicare Part A and Part B.

If you are enrolled in Medicare Part A and Part B, dependent verification documents are only required if you are enrolling a partner established through a state-registered domestic partnership or a legal union.

PEBB Continuation Coverage subscribers

When you enroll a partner established through a state-registered domestic partnership or a legal union.

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.
  • 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.
  • 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?

It depends on your situation.

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. This option is separate from PEBB My Account.

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.

Contact

The PEBB Program

Related forms and publications

  • 50-0704-pebb-declaration-tax-status-2023.pdf
  • 50-0100-employee-enrollment-guide-2023.pdf
  • 50-0400-public-employee-enrollment-change-form-2023.pdf
  • 50-0500-pebb-extended-dependent-certification.pdf
  • 50-0142-pebb-certification-child-with-disability.pdf

Connect with us

Contact HCA

Website feedback: Tell us how we’re doing

Footer
  • Accessibility
  • Interpreter services
  • Language access
  • Nondiscrimination
  • Privacy
  • Public disclosure requests
  • Public notices
  • Rulemaking
  • Work with us

Copyright © 2023 Washington Health Care Authority

Search hca.wa.gov
  • Free or low-cost health care
    • I need medical, dental, or vision care
      • Find Apple Health benefits & services
        • What are my basic covered services?
        • How do I get dental care?
        • Can I get vision care?
        • Other benefits & services
      • Other Apple Health programs
        • Noncitizens
        • Dual-Eligible Special Needs Plan (D-SNP)
        • Apple Health for Workers with Disabilities (HWD)
        • Family Planning Only (FPO)
        • Medically Intensive Children's Program (MICP)
        • Medicare Savings Program
        • Veterans & family members
      • Am I eligible?
        • Eligibility overview
        • Individual adults
        • Parents & caretakers
        • Pregnant individuals
        • Children
        • Age 65 & older, or Medicare eligible
        • Aged, blind, or disabled
        • Long-term care & hospice
        • Foster care
      • Learn about my coverage
        • Coverage with managed care
        • Coverage without managed care
        • American Indians & Alaska Natives
        • Coordination of benefits
        • Premium payment program
        • Patient review & coordination
        • Client rights
      • Use my coverage
        • How do I use my coverage?
        • Enrollment next steps
        • Make my first appointment
        • Transportation services (nonemergency)
        • Apple Health client booklets
      • Manage my coverage
        • Replace my services card
        • Change my health plan
        • Update my income or address
        • Pay my Apple Health premium
        • Cancel my coverage
    • I need behavioral health support
      • Mental health
        • Mental health crisis lines
        • Mental health services
        • Acute mental health care
        • Problem gambling
        • Mental health advance directives
      • Substance use
        • Substance use treatment
        • Alcohol use treatment
        • Opioid use treatment
      • Prenatal, children & young adults
        • Behavioral health services for prenatal, children & young adults
        • Wraparound with Intensive Services (WISe)
        • Family initiated treatment (FIT)
        • Early signs of psychosis
        • Housing for transitioning youth
      • American Indians & Alaska Natives
        • Behavioral health services for American Indians & Alaska Natives (AI/AN)
      • Recovery support services
        • What is recovery support?
        • Peer support & counseling
        • Recovery housing
      • Prevention
        • Substance use disorder prevention & mental health promotion
    • I help others apply for & access Apple Health
      • Apple Health Eligibility Manual
        • Apple Health eligibility manual overview
        • Introduction overview for general eligibility
        • General eligibility requirements that apply to all Apple Health programs
        • Classic (non-MAGI) based programs manual
        • Modified Adjusted Gross Income (MAGI) based programs manual
        • Long-term services & supports (LTSS) manual
      • Additional tools
        • Apple Health manual WAC index
        • Apple Health manual revision log
        • Program standards for income & resources
      • Stakeholder training & education
        • Training & education overview
        • Community-based training
        • Reference guides
        • Webinars, videos & presentations
        • Apple Health outreach toolkit
        • COFA outreach toolkit
        • Hospital Presumptive Eligibility
        • Medicaid suspension
    • Quick links
      • Apply for or renew Apple Health coverage
      • Apple Health for you
      • Apple Health account logins
      • Find forms & publications
      • Get help paying for prescriptions
      • Behavioral health facilities complaints
      • Ombuds services
      • General eligibility introduction
      • ​Program standard for income & resources
      • Voices of Apple Health
      • Voices of behavioral health & recovery
    • Contact Apple Health (Medicaid)
    • News
  • Employee & retiree benefits
    • Public employees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, FSA, & DCAP benefits
        • PEBB wellness programs
        • Medicare & PEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Defer as a survivor
        • Enroll as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
    • School employees
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Find a SEBB plan provider
        • Life, LTD, FSA, & DCAP benefits
        • SEBB wellness programs
        • Medicare & SEBB benefits while employed
      • Explore costs
        • Medical plan premiums
        • Life insurance premiums
        • Long-term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible employees
        • Verify & enroll my dependents
        • Waive my medical coverage
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
        • What happens if I stop working?
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
    • Retirees
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home & auto benefits
        • PEBB wellness programs
        • Medicare & turning age 65
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • How do I enroll?
        • Attend a retirement webinar
        • Verify & enroll my dependents
      • Learn how & why to defer
        • What is deferring & why would I?
        • How do I defer?
        • How do I enroll after deferring?
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
    • PEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits (including vision)
        • Dental plans & benefits
        • Benefits while traveling
        • Find a PEBB plan provider
        • Life, home, auto, AD&D, LTD, & FSA benefits
        • PEBB wellness programs
      • Explore costs
        • Medicare plan premiums
        • Non-Medicare plan premiums
        • Life insurance premiums
        • Long term disability insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify PEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with PEBB My Account
        • About Benefits 24/7
    • SEBB Continuation Coverage
      • Find benefits
        • Medical plans & benefits
        • Dental plans & benefits
        • Vision plans & benefits
        • Find a SEBB plan provider
        • Life & FSA benefits
        • SEBB wellness programs
      • Explore costs
        • Medical, dental & vision plan premiums
        • Life insurance premiums
        • Surcharges
        • Paying for benefits
      • Determine eligibility
        • Am I eligible?
        • Are my dependents eligible?
        • Are my survivors eligible?
      • Learn how to enroll
        • For newly eligible members
        • Verify & enroll my dependents
      • For survivors
        • Enroll as a survivor
        • Defer as a survivor
        • How do I notify SEBB that my loved one has passed away?
      • Manage benefits
        • What is special open enrollment?
        • Change my coverage
        • Change my address
        • Cancel my coverage
      • Get help
        • Contact the plans
        • Help with SEBB My Account
        • About Benefits 24/7
    • Quick links
      • Find forms & publications
      • Preparing for retirement?
      • Log into PEBB My Account
      • PEBB newsletters
      • Visit our PEBB Virtual Benefits Fair
      • File a PEBB appeal
      • PEBB rules & policies
      • PEB Board
      • Log into SEBB My Account
      • SEBB newsletters
      • Visit our SEBB Virtual Benefits Fair
      • File a SEBB appeal
      • SEBB rules and policies
      • SEB Board
      • For groups joining PEBB
    • Contact us
    • PEBB news
    • SEBB news
  • Billers, providers & partners
    • Prior authorization, claims & billing
      • Getting started
        • For new providers
        • Overview of prior authorization (PA), claims & billing
        • Document submission cover sheets
        • HIPAA Electronic Data Interchange (EDI)
        • Request a Zoom license
        • Audit & program integrity
      • Submit prior authorization (PA)
        • Step-by-step guide for prior authorization (PA)
        • Pharmacy prior authorization
      • Submit claims
        • Provider billing guides & fee schedules
        • Hospital rates & reimbursement
    • Program information for providers
      • Getting started
        • Program benefit packages & scope of services
        • Patient review & coordination (PRC)
      • Programs: A-E
        • 340B Drug Pricing Program
        • Applied Behavior Analysis (ABA) therapy
        • Behavioral health & recovery
        • Community behavioral support (CBHS) services
        • Dental services
        • Durable medical equipment & supplies
      • Programs: F-H
        • Family Planning Only
        • First Steps (maternity support & infant care)
        • Foster care & adoption support
        • Ground emergency medical transportation (GEMT)
        • Health Home
        • Home health care services: electronic visit verification
      • Programs: I-N
        • Indian health programs
        • Interpreter services
        • Kidney Disease Program
        • Managed care
        • Medicaid Administrative Claiming (MAC)
      • Programs: O-Z
        • Pharmacy services
        • Prescription drug discount card
        • School-based health care services
        • Substance use disorder (SUD) consent management guidance
        • Transhealth program
        • Transportation services (nonemergency)
    • Become an Apple Health provider
      • Learn how to enroll
        • Enrollment overview
        • Eligible provider types & requirements
        • Enroll as a billing provider
        • Enroll as a health care professional practicing under a group or facility
        • Enroll as a nonbilling provider
        • Enroll as a billing agent or clearinghouse
      • What's next
        • Find next steps for new Medicaid providers
      • For existing medicaid providers
        • Update my provider information
        • Revalidation
    • Learn ProviderOne
      • Getting started
        • How do I access ProviderOne?
      • Training materials
        • ProviderOne Billing & Resource Guide
        • User manuals
        • ProviderOne for social services
        • Fact sheets
        • Webinars
    • Quick links
      • Log into ProviderOne
      • Find billing guides & fee schedules
      • Find forms & publications
      • Sign up for Provider Alerts
      • ProviderOne Billing & Resource Guide
      • ProviderOne Discovery Log
      • ProviderOne maintenance
      • Termination & exclusion list
    • Contact us
    • News
  • About HCA
    • Programs & initiatives
      • A-H
        • Advancing clinical integration
        • Apple Health (Medicaid)
        • Behavioral health & recovery
        • Cascade Select (public option)
        • Clinical collaboration & initiatives
        • Health Information Technology
        • Health Technology Assessment
      • I-S
        • Making informed health care decisions
        • Medicaid Transformation Project (MTP)
        • Public Employees Benefits Board (PEBB)
        • School Employees Benefits Board (SEBB)
      • T-Z
        • Trauma-informed approach
        • Uniform Medical Plan (UMP)
        • Value-based purchasing (VBP)
        • Washington Prescription Drug Program (WPDP)
        • Washington Wellness
    • Who we are
      • About us
        • Our leadership
        • Our mission, vision & values
        • Health equity
          • Pro-Equity Anti-Racism (PEAR)
        • Tribal relations
        • Legislative relations
      • Boards, committees & collaborations
        • Overview of groups
        • Governor's Indian Health Advisory Council
        • Health Care Cost Transparency Board
        • Universal Health Care Commission
      • Health innovation
        • Health care reform
        • Performance measures
        • Tech modernization
        • Washington State Common Measure set
    • Data & reports
      • Reports & dashboards by program
        • Apple Health (Medicaid) & managed care
        • Apple Health client eligibility
        • Apple Health providers
        • Behavioral health & recovery
        • Dental data
        • Health Home
        • Interpreter services
        • PEBB Program enrollment reports
        • Reproductive health
        • SEBB Program enrollment reports
      • Data dashboards
        • Analytics, research & measurement (ARM) data dashboard suite
        • Emergency department
        • Foundational Community Supports provider map
        • Inpatient facility
        • Medicaid maternal & child health measures
        • Washington State Medicaid Explorer
        • Opioid use disorder treatment
        • Behavioral health housing program map
        • Healthier Washington measures
      • Additional reports
        • HCA budget information
        • Legislative reports
        • Washington State All Payer Claims Database (WA-APCD)
    • Other administrative activities
      • Medicaid-related
        • Fraud prevention
        • Medicaid program integrity
        • Personal injury, casualty recoveries & special needs trusts
      • Government transparency
        • Gender identity information
        • Public disclosure request
      • Community services
        • Disaster outreach
        • Voter registration
    • News
      • Find out what's new
        • Information about novel coronavirus (COVID-19)
        • News releases
        • Announcements
        • Public notices
        • Subscribe to HCA news
      • Follow HCA on social media
        • Facebook
        • Twitter
        • Instagram
        • Medium
        • HCA Connect
        • LinkedIn
        • YouTube
      • For the press
        • Visit our press room
      • HCA Connect
    • Quick links
      • Work with us
      • Find news releases
      • Voices of HCA
      • Appeals
      • Rulemaking
      • Medicaid (Title XIX) State Plan
      • Policies
    • Contact HCA
  • Contact