Health Fund

Eligible Dependent Chart

Dependents Eligible for Coverage	Required Documentation
Lawful Spouse	A completed Dependent Enrollment Form and a certified copy of your marriage certificate.
Dependent Children up to age 26	A completed Dependent Enrollment Form and a copy of their birth certificate (if newborn a copy of the hospital birth record will suffice until you receive the official birth certificate).
Adoption/Guardianship	A completed Dependent Enrollment Form and a copy of the adoption/release papers, guardianship or placement papers issued by a court of law.
Mental and Physical Handicapped Dependents age 26 and older	A completed Dependent Enrollment Form and a completed Disability Application along with any other proof of incapacity including medical records and a statement of financial support.