Open Enrollment: Required Documents

How do I enroll only myself?

Complete Employee information section on the Enrollment Form. You must include your Social Security Number.

How do I enroll my spouse and myself?

Complete Employee and Spouse information sections on the Enrollment Form and include SSNs for both you and your spouse. Claims cannot be paid until this information is given. In certain cases, a marriage certificate may be requested.

How do I enroll one or more children?

Complete Employee, Spouse and Children information sections for employee, spouse and each child on the Enrollment Form and include SSNs for all covered individuals. Also, include copies of the following documents, if applicable:

IMPORTANT: Spouse information is required for Coordination of Benefits purposes even if spouse coverage is not elected.

Dependent Child from a Previous Marriage
- The complete Divorce Decree & Settlement of the natural parents

- Birth Certificate of child
- The complete Divorce Decree & Settlement of the natural parents
- Marriage Certificate to current spouse

Child Born Outside of Marriage
- Court Order regarding insurance
- Birth Certificate of child
- Name and birth date of other natural parent, including information regarding any other insurance coverage

Child for Which You are Guardian
- Guardianship / Custody documents

Adopted Child
- Final Adoption Papers
- If the adoption is not yet final, please provide a copy of the Placement Agreement

Adult Child
- Birth Certificate of the child