Dependent Verification

How to add a dependent to your coverage.

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If you are an Agency Provider (AP) or a CDWA Individual Provider (IP) and have healthcare coverage through SEIU 775 Benefits Group (or you are eligible), you can enroll your dependent children (under the age of 26) in health and dental coverage at the full premium cost. The cost ranges from $686-$766 per month depending on your health plan, and is the same total cost whether you have 1 or more dependents enrolled. 

To add a dependent(s), you must:

  1. Fill out and submit the dependent section of the Health Benefits Application. 
  2. Provide a document that verifies your relationship to your dependent(s) within 60 days. You can do this by mail or using My Plan.
  3. Begin paying the full premium through payroll deduction. 

Postage is required when you mail, but submitting your Health Benefits Application is easy.

Online with My Plan Mail
Learn more about My Plan. SEIU 775 Benefits Group
PO Box 24811
Seattle, WA 98124

More Details

  • You will have 60 days after your Application is received to send a document that proves your relationship to your dependent(s). You can return you Dependent Verification document with your application or send it separately to the address on the Health Benefits Application. If you are returning your document separately, please include your name, last four digits of your Social Security number and phone number so that it can be matched to your application.
  • If you choose to send your document after you submit your Health Benefits Application, make sure to include your name and date of birth with it.
  • Make sure to send a copy and not the original document. 
  • After submitting your Application and your document proving your relationship, you will get an email (if you have an email address on file) or a letter in the mail about the status of your application. 

Types of Dependents

Below is a list of qualified child dependents. Click the “+” to see which documents you can use as verification for each type of dependent. If you have questions or need help enrolling a child dependent, call customer service at 1-877-606-6705.

 

  • Government-issued birth certificate that includes all parents’ names. 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent(s) and listed as a son or daughter. Make sure to black out financial information. 
  • Hospital certificate with the child’s footprints on it. Must show the name of the parent who is the subscriber, the subscriber’s spouse or the subscriber’s state-registered domestic partner. 
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. government.
  • Birth certificate or adoption certificate. 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter. Make sure to black out your financial information. 
  • Certificate or decree of adoption. Must show the name of the parent who is the subscriber, the subscriber’s spouse, or the subscriber’s state-registered domestic partner. 
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. Government. 
  • Birth Certificate as well as government-issued marriage certificate and a  federal tax return within the last 2 years with your spouse listed and proof of joint ownership (mortgage statements, bank statements, credit card statements, lease/rental agreements). 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter (make sure to black out your financial information). 
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. Government.
  • Legal documentation from state or federal government that shows legal guardianship status. 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter. Make sure to black out your financial information.
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. Government. 
  • Original foster child certification and copy of documentation of regular and substantial support of the child. 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter. Make sure to black out your financial information. 
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. Government.
  • Government-issued birth certificate; includes name of the domestic partner. 
  • Court orders naming the domestic partner as the legal guardian. 
  • The most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter. Make sure to black out your financial information. 
  • Court-ordered parenting plan. 
  • National Medical Support Notice. 
  • Defense Enrollment Eligibility Reporting System (DEERS) registration. 
  • Valid J-2 visa issued by U.S. Government.

*If you are enrolling your stepchild or your domestic partner’s child, you must also provide a document proving your relationship to your spouse or domestic partner.