PEBTF Healthcare Coverage for Dependents

  • Eligible Dependents

    You may elect to add the following dependent to your PEBTF healthcare coverage:

    Legal Spouse

    Domestic Partner

    Child Under Age 26, including:

    • Your natural child
    • Legally-adopted child
    • Stepchild 
    • Child for whom you are the court-appointed legal guardian or legal custodian
    • Eligible foster child
    • Child for whom you are required to provide medical benefits by a Qualified Medical

    Enrollment Rules and Required Documentation

    • Employees are required to present documentation verifying the eligibility status for their dependents. 

      • Spouse - Marriage Certificate 
      • Domestic Partner  - Notarized Domestic Partner Certification with three documents to support domestic partnership – all of the documents must be dated at least 6 months prior to the current date
      • Natural Born Child - Birth Certificate
      • Step-Child - Birth Certificate of Child and Marriage Certificate
      • Adopted Child - Adoption Papers or Court Appointed Custody documents
      • ORIGINAL documentation must be providedPhotocopies ARE NOT ACCEPTABLE.  Original documents will be verified and returned to you. 
    • A dependent spouse/domestic partner who is eligible for medical or supplemental benefit coverage through his or her own employer must take his or her employer's coverage as his or her primary coverage regardless of any employee contribution the spouse/domestic partner must pay and regardless of whether the spouse/domestic partner had been offered an incentive to decline such coverage.
    • You may enroll your eligible Dependent at any time. However, the effective date cannot be more than 60 days retroactive from the date the PEBTF Enrollment/Change Form is received by the Office of Human Resources.