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List of Acceptable DEVA Documents

List of Acceptable DEVA Documents

Married Spouse, or Qualified IRS Domestic Partner Dependent*
Submit one of the following documents as proof of cohabitation/financial interdependency within the last 12 months:

Federal Tax Return listing your spouse. Please provide a filed copy of page 1 and page 2 of your tax return (or pages 1, 2 and 3 if you filed a 1040-SR Form), which includes your dependent’s name and signatures. IRS E-file Signature Authorization Form 8879 can be provided if e-filing. Be sure to redact or cross out Social Security Numbers and any financial information before submitting.

Non-IRS Qualified Domestic Partner Dependent
Submit one of the following documents which include your domestic partner, as a co-owner/co-signer, demonstrating cohabitation/financial interdependency within the last 12 months:

Mortgage Statement
Lease Agreement
Homeowners or Renter’s Insurance Statement
Auto Loan or Auto Insurance Statement
Bank Statement (active account)
Municipality/County Property Tax Statement

Natural Born Child(ren) or Step-child(ren)
Submit a copy of the official birth certificate for each child for whom you are providing health coverage. Birth verifications received from a hospital are not acceptable forms of verification.

Birth Certificate

Adopted Child(ren), Child(ren), Legal Guardianship or Court Order
Submit a copy of the adoption certificate, court order or decree assigning legal guardianship.

Adoption Certificate or Court Order/Legal Guardianship Decree

*IRS Code Section 152 states that a dependent meets the IRS standard for tax-favored premium contributions if: Member lives with the enrolled dependent for the full taxable year, except for temporary absences for reasons such as vacation, military service, or education; enrolled dependent is a U.S. citizen, U.S. national, or a resident of the U.S., Canada or Mexico; the enrolled dependent received more than half of his or her support from Member during the tax year; enrolled dependent is not your “qualifying child” nor anyone’s “qualifying child.”