Dependent Eligibility / Dependent Supporting Documentation If you are adding new dependent(s) to your State health plans, you must submit the appropriate supporting documentation either via Workterra – the State's online enrollment system – or via fax to the Office of Employee Benefits: You are strongly recommended to scan and upload your supporting documentation via the "Upload Documents" option in Workterra. The supported formats are: txt, pdf, rtf, ppt, pptx, xls, xlsx, doc, docx. The max file size is 4096 KB. If you don't have access to a scanner, you can instead take a clear picture of the supporting documentation with your smartphone and save it as a PDF for uploading. You may also fax the supporting documentation to OEB at (401) 574-9281. You must use a fax cover sheet and clearly indicate your full name, date of birth, and last 4 digits of SSN. Without a fax cover sheet, the addition and enrollment of your dependent(s) may be delayed. Please note: Anyone NOT shown in the table below is ineligible to be covered as a dependent. Dependent Relation Supporting Documentation Notes / Exceptions Spouse A copy of the marriage certificate Dual State-employed spouses – Where two State-employed spouses were both hired on or after June 29, 2014 and are both covered under one family plan, the co-share shall be based on the income of the higher earner as determined by the annualized total rate of pay. Further, the spouse that does not pay the co-share is ineligible to receive the waiver opt-out payment. Ex-spouse – Per RI General Laws 36-12-2.5, ex-spouses are not eligible for coverage unless the ex-spouse has been continuously covered by State employee health coverage since before January 1, 2014. If your divorce was finalized after January 1, 2014, your ex-spouse and any step-children lose eligibility for State health coverage as of the date of the final divorce decree. You are required to initiate a qualifying event in Workterra to remove them from your coverage. If you fail to do so within 31 days of your final divorce decree, COBRA will not be offered once they are removed, and you could be liable for any claims paid by the State health plan on their behalf after the date of the final divorce decree. Common Law Spouse Copy of most recent IRS Form 1040 Married federal income tax filing status – The IRS allows common law spouses to file their taxes married-joint if they live in a state like Rhode Island that recognizes common law marriage. Because common law spouses receive the same favorable pre-tax benefits treatment as spouses that can provide a marriage certificate, employees wishing to cover a dependent as a common law spouse must provide a copy of their most recent federal income tax filing showing married-joint or married-separate tax filing status. In the absence of such a tax filing status, the dependent may still be eligible for coverage as a domestic partner. Domestic partner Domestic partnership affidavit (completed as a digital form in Workterra), AND At least TWO of the following four items (items in #3 count as one): Domestic Partnership Agreement or a Relationship Contract Joint mortgage or joint ownership of primary residence TWO of the following four items proving financial interdependency: Joint ownership of vehicle Joint checking/savings account Joint credit account Joint lease Employee's will, retirement contract, or life insurance showing domestic partner as beneficiary Imputed Income – Pursuant to federal guidance, under the State employee health plan the fair market value of any health coverage extended to a domestic partner will be imputed to you as income on your paycheck. This imputed income would be added to the your federal taxable gross wages, State taxable gross wages and social security taxable wages. Additionally, any coverage provided to a domestic partner is paid for on an after-tax basis. You will have additional tax withholdings based on the imputed income and the increased taxable wages due to the reduction in pre-tax contribution. The amount of imputed income is generally around $200 per pay period for medical/prescription, dental and vision coverage, and the amount of the reduction in pre-tax contribution is generally around $100 for the same coverage. This means that you will have additional tax withholdings based on approximately $300 per pay period. Generally, the additional tax withholdings will be in the same proportion as your normal tax withholdings are to your regular pay. Marriage – If you and your domestic partner get married, it is YOUR responsibility to inform the Office of Employee Benefits in writing immediately. Your failure to do so will prevent you from obtaining refunds of additional tax withholdings based on imputed income. The Office of Employee Benefits will not coordinate such refunds if it is not notified within 31 days of the date of the marriage. Termination of domestic partnership – If your domestic partnership ends, you will not be able to drop your domestic partner from your coverage until open enrollment (for effect January 1 of the following year) unless your domestic partner experiences a qualifying status change. Addition of new domestic partner – If you drop your domestic partner, you will not be able to add a new domestic partner for at least 6 months, assuming your new domestic partner meets all eligibility requirements. Child Birth – A copy of the birth certificate (We understand that this takes time. Please add your newborn as a dependent within 31 days of date of birth and follow up with the birth certificate once received; same for the social security number.) Adoption – A copy of the adoption decree Legal guardianship – A copy of the court decree awarding legal guardianship Step-children – Step-children are eligible. A birth certificate proving the employee’s spouse is the step-child’s parent must be provided. Foster children / grandchildren – Foster children and grandchildren are not eligible unless the employee adopts or has legal guardianship over them. Handicapped / disabled children – Handicapped / disabled children are eligible beyond their 26th birthday if their physician certifies them as handicapped / disabled and if they are receiving Social Security benefits. Please contact OEB for additional information or assistance. Children of domestic partner – Children of a domestic partner are not eligible unless the employee adopts them or marries their parent.