Supporting Documentation Required for Benefits Enrollment and Changes

Overview

‍The benefit plan elections you make are for the entire calendar year and generally cannot be changed outside the Annual Open Enrollment period. However, if you have a Qualified Life Event as defined by the IRS, you will be able to make benefit changes that are consistent with the life event.

The University of Northern Iowa is responsible for managing our benefit plan resources wisely and applying dependent eligibility rules fairly and equally. For these reasons, employees must provide supporting documentation when enrolling in or making benefit changes to verify their family members are eligible to be covered under our plan and to support the change in benefits

Human Resource Services

Examples of Supporting Documentation

(legible copies are acceptable)

Change in Family Status

  • Natural Child
    • Birth certificate, or hospital birth record indicating the employee is the child’s parent, or.
    • Passport indicating the employee is the child’s parent, or
    • Court order establishing the employee’s financial responsibility for the child’s medical, dental, or other health care, or
    • Copy of public aid order indicating the employee must provide health insurance through the employer.
  • Adoption
    • Adoption decree/order with judge’s signature and circuit clerk’s file stamp, or
    • Petition for adoption with circuit clerk’s file stamp, or
    • Letter of placement by an adoption agency.
  • Legal Guardianship
    • Court document signed by judge and stamped by the circuit clerk showing legal guardianship
  • Disabled Dependent
    • Documentation from licensed physician detailing the dependent's disability and that the disability existed before age 19, and a statements from the Social Security Administration with the Social Security disability determination or a court order adjudicating the disability.
  • Death of your spouse/domestic partner/common law spouse or dependent child
    • Death Certificate, or
    • Certified copy of the public record of death, or
    • Certified copy of a coroner’s certificate
  • Divorce/Dissolution of Partnership 
    • Divorce or separation decree, or
    • Legal separation agreement, or
    • Dissolution of Domestic Partnership form

Change in Coverage

When adding or terminating benefit coverage for family members, supporting documentation must be provided along with documentation of the qualifying life event.

  • Proof of union
    • Marriage license / certificate, or
    • Notarized copy of public record, or
    • Declaration of Same-sex Domestic Partnership for Enrollment or Eligibility, or
    • Affidavit of Domestic Partnership, or
    • Registration of Domestic Partnership, or
    • Affidavit of Dependency for Tax Purposes, or

    • Birth certificate

      AND

    • Spouse coverage status change (enrollment or termination notice, etc.), or
    • Spouse employment status documents (offer letter, COBRA notice, etc.), or
    • Letter from other employer documenting loss or gain of coverage and date, or
    • Court/Administrative Orders to initiate or end coverage, or Letter from insurance provider where coverage was lost or gained (i.e. Iowa Health plan, hawk-i, other country), If dependent is moving from outside the U.S. to live within the U.S. and you are adding them to your coverage, you must also provide evidence of the event such as a copy of Visa or Passport showing entry into U.S.

Change of Residence

  • Change of residency for your spouse/domestic partner/common law spouse or dependent child
    • Voter registration card, or
    • Vehicle registration certificate, or
    • Rental or lease agreement showing 30 days of residency

Contact Information

Senior Benefits Analyst

Jesse Lahmann
(319) 273-2423
Jesse.Lahmann@uni.edu

‌Wherever conflicts occur between the contents of this site and the contracts, rules, regulations, or laws governing the administration of the various programs, the terms set forth in the various program contracts, rules, regulations, or laws shall prevail. Space does not permit listing all limitations and exclusions that apply to each plan. Before using your benefits, review the plan's coverage manual. Benefits provided can be changed at any time without the consent of participants.