Verification
Dependent and Change Documentation
What you need to know
Whenever you enroll dependents in your Simplot coverage, you’ll be asked to submit documentation to verify your dependents are eligible. You also need to provide documentation if you’re adding or removing a dependent after a life event. Read on to see which documentation is acceptable when you’re enrolling and what’s acceptable after a life event.
When Enrolling Dependents
When you first enroll dependents, you will be required to submit documentation to the Plan Administrator within 75 days from the date of your event. The following documents are acceptable.
| Dependents | Supporting Documentation |
|---|---|
| Spouse* | Government-issued marriage certificate |
| Biological Child | Government-issued birth certificate |
| Disabled Child | 1. Government-issued birth certificate and 2. Disabled Dependent Certification form. To request the form, call Blue Cross at 855-216-6850 or log in and download it from www.bcidaho.com. Return the form to Blue Cross of Idaho. |
| Adopted Child | Placement for Adoption Agreement and/or Adoption Certificate signed by judge |
| Foster Child | Official, signed legal document placing the child under your foster care |
| Stepchild | 1. Government-issued birth certificate and 2. Marriage certificate for employee and child’s natural or adoptive parent |
| Legal Dependent Child | Copy of legal guardianship |
* In jurisdictions where common law spouses are legally recognized, contact the Simplot Benefits Service Center to discuss the documentation required to verify a common law marriage.
** Must meet the legal requirements of State Domestic Partnership.
*** If the Taxation of Domestic Partner Health Benefits form is not received by the documentation deadline, your Domestic Partner’s benefits will be taxable and will result in imputed income to you.
Making Changes Due to a Life Event
If you are making changes — including adding or removing dependents from coverage — due to a life event, you will be required to submit documentation to the Plan Administrator within 75 days from the date of your event. The following documents are acceptable.
| Dependents | Supporting Documentation |
|---|---|
| Marriage* | Government-issued marriage certificate |
| Birth | Government-issued birth certificate |
| Adoption | Placement for Adoption Agreement and/or Adoption Decree signed by judge |
| Fostering a Child | Official, signed legal document placing the child under your foster care |
| Acquisition of a Legal Dependent | Copy of legal guardianship |
| Divorce/Annulment | Court-issued divorce decree or legal annulment |
| Legal Separation | Legal separation agreement |
| Employee, Spouse or Dependent Gains Other Coverage | Letter verifying other coverage from insurance company |
| Employee, Spouse or Dependent Loses Other Coverage | – Letter from previous employer with coverage end date or – Letter from previous insurance verifying loss of coverage or – COBRA notification with coverage end date |
| Loss or Gain of CHIP or Medicaid Coverage | Letter verifying loss or gain of CHIP or Medicaid coverage from state agency or carrier |
| Death of Spouse or Dependent | Death certificate |
* In jurisdictions where common law spouses are legally recognized, contact the Simplot Benefits Service Center to discuss the documentation required to verify a common law marriage.
** Must meet the legal requirements of State Domestic Partnership.
*** If the Taxation of Domestic Partner Health Benefits form is not received by the documentation deadline, your Domestic Partner’s benefits will be taxable and will result in imputed income to you.