Palmdale School District

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  • BENEFITS:

    DEPENDENTS

     

    In order for SISC to maintain and preserve the integrity of health plan you must provide proof of eligibility of your dependents (i.e. spouse / domestic partner, children, etc), when they become eligible for benefits. Proof of eligibility will be required when adding a new dependent and at the time of hire for a new employee.

     

    FAILURE TO SUBMIT SUPPORTING DOCUMENTATION WITHIN 30 CALENDAR DAYS
    OF QUALIFYING EVENT MAY RESULT IN YOUR DEPENDENTS BEING DENIED COVERAGE.

     

    Who is an eligible dependent?

    Spouse:

    The employee's legally wed spouse as defined by state law.

    Must provide:

    • Copy of Federal Tax return (first page) for 2015 or 2014 with "married filing joint." If filing separately, then copies of each Federal Tax Return (first page). (It is alright to black out any financial information below the "exemptions" section).
    • A copy of the marriage certificate that is witnessed and signed immediately following the ceremony or Certificate of Marriage (legal document from the Hall of Records).

     

    Domestic Partner Subject to AB205: 

    Only same sex domestic partners age 18 and older and opposite sex domestic partners ages 18 through 61.

    Must provide:

    • A certified copy of the Declaration of Domestic Partnership that was filed with California Secretary of State and submit a completed and signed enrollment or change form within 30 calendar days of the date they register with the state or wait until the next Open Enrollment Period.
    • A signed affidavit when adding an opposite sex domestic partner age 18 through 61 (affidavit may be obtained from SISC). When one or both domestic partners are 62 years of age or older, they must register with the state of California.

    Child/Child of Domestic Partner:

    A natural child or step-child from birth to age 26; a legally adopted child or a child who is in the process of being adopted; a child for whom the member has legal and physical custody/guardianship to age 18. A child who is in the process of being adopted  is considered legally adopted when SISC receives legal evidence of (i) the intent to adopt; and (ii) the member has either: (a) the right to control the health care of the child; or (b) assumed a legal obligation for full or partial financial responsibility for the child in anticipation of the child's adoption.

    Must provide:

    • Copy of Birth Certificate or Adoption/Legal Guardianship Court Documents

     

    Disabled Dependent:

    A disabled dependent may be eligible to continue coverage beyond age 26 if unmarried and a dependent for Federal Income Tax purposes (proof required). 

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