Dependent Eligibility Chart

Required Documentation for Benefits Enrollment and Termination

Dependent Eligibility & Required Documentation for FCPS Health Plan Coverage

FCPS requires documentation demonstrating all insured dependents meet eligibility criteria. You have 30 calendar days from a qualifying event to complete and submit your medical and dental plan enrollment forms along with applicable documentation from the chart below to verify your dependent’s eligibility before coverage will become effective.

Dependents

Eligibility Definition

Documentation Required

Spouse A person to whom you are legally married

Photocopy of the first page of the employee's most recent IRS Form-1040 that includes the employee's filing status, which must be "Married filing jointly" or "Married filing separately" (you may remove all financial information). The filing status must reflect "Married" as proof of marital status.

AND 

Photocopy of marriage certificate

Biological Child* A biological son or daughter of the retiree Photocopy of birth certificate showing employee’s name
Adopted Child* An adopted son or daughter of the retiree or a child placed for adoption

Photocopy of the Final Adoption 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

Stepchild of a Current Marriage* A stepson or stepdaughter of the retiree

Photocopy of birth certificate showing employee’s spouse’s name; 

AND 

Photocopy of marriage certificate showing the employee and child’s parent’s name

Child under Legal Guardianship* A child for whom the retiree 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 retiree 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 retiree 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 that has been approved by the carrier

*Children must be under age 26 unless disabled. 

 

Examples of ineligible individuals include:

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

 

If the source document is not in English, you must have the document translated prior to supplying it to the Office of Benefits Services. 

Document copies can typically be obtained in the locality where the birth or marriage occurred, or via the following websites: www.vitalchek.com or www.vitalrec.com; www.irs.gov/taxtopics/tc156.html (for a copy of tax return). Fees will likely apply.

HR Connection

Question for Human Resources? Submit it through the HR Connection portal or call 571-423-3000 or 1-800-831-4331.