Documentation Requirements for Dependents

Children can be covered until the last day of the month in which they turn age 26. Disabled dependents can be covered beyond age 26, if additional documentation is submitted. In the event of divorce or dissolution of domestic partnership, that individual must be removed through a status change request and will be offered COBRA insurance coverage. Enrollment will not be processed without all required documentation. Please note that international documents without an official English translation will not be accepted. Supporting documentation can be submitted via:

  • Email to hr-benque@pitt.edu (exclude any SSNs) or
  • Fax at 412-624-3485 or
  • U.S.P.S. mail to:
    320 Craig Hall
    200 South Craig Street
    Pittsburgh, PA 15260
     

Relationship Type

Required Documentation

 Spouse

Marriage Certificate

 Domestic Partner1

University approved Affidavit of Domestic Partnership

 Natural Child

Birth Certificate

Adopted Child

Adoption certificate stamped by the circuit clerk

Step Child

 Birth Certificate indicating your spouse is the child's parent and marriage certificate indicating you are married to the child's parent

Child of Approved Domestic Partner

Birth Certificate indicating your domestic partner is the child's parent and the University approved Affidavit of Domestic Partnership indicating you are in a domestic partnership with the child’s parent.

Disabled Over Age Child

Eligibility will be continued past the age of 26 for dependent children who, as medically certified by a physician, are incapable of self-support due to mental or physical disability, mental illness or a developmental disability that started before age 19. Initial certification with the insurance carriers as well as an annual recertification is required. Please contact carriers with questions.

Legal Guardianship

Court documentation signed by a judge and stamped by the circuit clerk

Adjudicated Child

Judicial Support Order from a judge or a copy of Qualified Medical Support Order with the page that indicates the member must provide health insurance through the employer.

1View this page for more information on Domestic Partner benefits.