Eligible Dependents

Eligible Dependents

Besides establishing benefits for yourself, you may also cover the following eligible dependents:

Spouse/partner

• If adding Domestic Partner (Domestic Partner FAQ)
• Complete a Domestic Partner Affidavit or submit a copy registration.
  • Add a domestic partner’s child by completing Affidavit of Child Dependency
  • Same sex domestic partner that is a Federal tax dependent please complete Domestic Partner Certification for Dependent Tax Status
• Domestic Partner Coverage Imputed Value this is the amount added to your taxable income

Dependent Child (through the month they turn 26)

• An eligible employee’s, spouse’s, or domestic partner’s son, daughter, stepson, stepdaughter, adopted child or child placed for adoption, foster child or another legally placed child; or
• The biological child of an eligible dependent child of an eligible employee, spouse, or domestic partner (a grandchild) and meets one of the following criteria:
  • The child’s parent will not be older than age 26 on the last day of the plan year, is unmarried and without a domestic partner, both the child’s parent and the child live in the household of the eligible employee, and both receive over half of their financial support from the employee; or
  • The child lives with the eligible employee and the employee is legally responsible for the welfare of the grandchild. The employee must provide legal documentation of guardianship, conservatorship, or other custody documents upon enrollment.
    • Complete a Grandchild by Affidavit form
• A Child by Affidavit includes but is not limited to a foster child, grandchild, a child placed for adoption, or court-ordered placement of a child who lives in the household of the eligible employee, and is the eligible employee’s IRS dependent. 
  • The employee must provide court-ordered documentation of guardianship and the notarized Affidavit of Child. Coverage ends the last day of the month in which the court-ordered guardianship ends or age 18, whichever comes first.
    • Affidavit of Child Dependency
• There is no age limit for a dependent child who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability when all the criteria in this section are met. 
• Please contact PEBB at 503-373-1102 to enroll a disabled dependent child