Get the free Dependent Verification Affidavit - medschoolhr wustl

This affidavit is used by members of Washington University to verify the eligibility of dependents for health and dental insurance coverage during the annual enrollment period.

How to fill out dependent verification affidavit

How to fill out Dependent Verification Affidavit

1. Obtain the Dependent Verification Affidavit form from your employer or the relevant benefits department.
2. Fill in your personal information, including your name, employee ID, and contact details.
3. List all dependents you want to verify, including their names, relationships to you, and dates of birth.
4. Provide documentation for each dependent, such as birth certificates, tax returns, or marriage certificates, as proof of their dependent status.
5. Review the affidavit for accuracy and completeness.
6. Sign and date the form, certifying that all information provided is true and correct.
7. Submit the completed affidavit and attached documentation to the correct department by the specified deadline.

Who needs Dependent Verification Affidavit?

1. Individuals who wish to enroll their dependents in employer-sponsored health insurance or other benefits plans.
2. Employees whose dependents' eligibility for coverage needs verification, typically during open enrollment or after a qualifying life event.

People Also Ask about

What does dependent verification mean?

Dependent Eligibility Verification (DEV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (dependents) enrolled in health and/or dental benefits.

What is your dependent verification?

Eligibility verification procedures can help minimize legal risks. A verification program facilitates a proper understanding of who is eligible under a group health plan. This learning process increases employee accountability for their benefit elections.

How to prove someone is your dependent?

If you have the birth certificate to show that you are the father and a letter from your girlfriend to show that you live in the same household should be sufficient evidence to show that the child is your dependent.

What is a dependent verification form?

AFFIDAVIT OF DEPENDENCY. The undersigned, being first duly sworn, under oath says that dependent's name) (birthdate) (relationship) is a dependent of mine (dependent meaning: natural child, legally adopted child, foster child or stepchild) in that he/she meets the following requirements: 1.

Who is considered a dependent on insurance?

A dependent may be a spouse, domestic partner, or child (some plans refer to "spouse and dependents" meaning that they differentiate between the spouse and the children). You can cover your biological, adopted, and stepchildren.

What is the meaning of dependent in affidavit?

Dependent Eligibility Verification (DEV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (dependents) enrolled in health and/or dental benefits.

What is a dependent care verification form?

This form is to be completed by your provider after dependent care expenses have been incurred and should be used in place of dependent care documentation. Attach this form to an online or debit card claim via your online account or to a Claim Form.

For pdfFiller’s FAQs

What is Dependent Verification Affidavit?

A Dependent Verification Affidavit is a legal document used to confirm the eligibility of dependents for benefits or coverage in a particular program, often requiring the policyholder to affirm that the individuals claimed as dependents meet specific criteria set by the organization.

Who is required to file Dependent Verification Affidavit?

Typically, employees or policyholders who wish to enroll their dependents in insurance plans or benefits programs are required to file a Dependent Verification Affidavit, especially if requested by the employer or insurance provider.

How to fill out Dependent Verification Affidavit?

To fill out a Dependent Verification Affidavit, individuals must provide personal information about themselves and each dependent, detail the relationship with the dependents, and sometimes include supporting documentation to prove the dependency status, such as birth certificates or tax documents.

What is the purpose of Dependent Verification Affidavit?

The purpose of a Dependent Verification Affidavit is to ensure that only eligible dependents are covered under an insurance plan or benefits program, reducing fraud and misrepresentation, while maintaining the integrity of the benefits system.

What information must be reported on Dependent Verification Affidavit?

Information that must be reported on a Dependent Verification Affidavit typically includes the employee's name, contact information, a list of dependents along with their birthdates and relationship to the employee, and relevant supporting documents that verify the dependency status.