Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 447 Eligible Dependents are: a.  A spouse — husband or wife, of the opposite or same sex, with whom you are legally married; b.  An unmarried/married dependent child regardless of student status until the end of the birth month in which he or she reaches age 26; c.  An unmarried/married dependent child who is incapable of self-support because of a mental and/ or physical disability and who depends on you for support. *  Ineligible dependents are: domestic partners and civil union partners, both same sex or opposite sex. The term “Dependent child” means any of the following: a. Biological children; b.  Legally adopted children or children placed in the employee’s home pending final adoption; c. Stepchildren; d. Foster children; e.  Children who are under the legal guardianship of the employee; f.  Children for whom the employee is required to pro- vide health care coverage under a recognized Quali- fied Medical Child Support Order; Coverage Effective Date for Newly Enrolled Dependents Coverage is effective on January 1, 2017 for eligible, newly enrolled dependents. Dependent Eligibility Verification In order to provide coverage for your newly enrolled de- pendents, you must submit proper legal documentation to Human Resources no later than November 10, 2016. Spouse: marriage certificate Dependent child: birth certificate Stepchild: birth certificate AND marriage certificate. Foster child, adopted child or child whom you have legal guardianship: birth certificate AND legal docu- ments from the court. Any NEWLY ENROLLED dependent child between the ages of 19-26: Documents listed above AND a completed AND notarized affidavit. See below. Age Limits Dependent children may be covered through the end of the birth month in which they turn 26. Prior to January 1, 2015, WSSC required a completed and notarized affidavit to cover any dependent children between the ages of 19-26. Now, we only require submission of an affidavit for newly enrolled dependents between the ages of 19-26. You will not need to submit an affidavit if your overage dependent child is already enrolled on our plan(s). The affidavit is in Human Resources, on the Intranet and One-Source. Insurance Coverage for Dependents WHAT IF I HAVE QUESTIONS OR NEED ADDITIONAL INFO? Contact the Benefits Team in Human Resources at hr_benefits@wsscwater.com or call (301) 206-7034.