Dependent Verification Proof
Employees and retirees who cover a dependent for Pinellas County medical, dental, or life insurance benefits need to provide documentation to prove the relationship between them and the dependent. Submit the documents to Employee Benefits no later than 31 days from the date of the qualifying event, or 60 days for birth or adoption.
- New hire: Submit the documents after making your benefits selections in EBS (OPUS). See the New Hire Benefits Screenshots Guide for step-by-step instructions.
- Current employee with a family status change (qualifying event) during the year such as marriage or birth will submit the documents along with the Qualifying Event Status Change Form.
- Retiree with a family status change (qualifying event) during the year such as marriage or birth will submit the documents along with the Retiree Group Insurance Mid-Year Change Form.
Gather Documents & Protect Your Personal Information
Before submitting your documents to Benefits, remove your sensitive information:
- Copy your original document. You only need to provide the first page for a tax return or financial statement.
- Mark out financial information, account numbers, and Social Security numbers before submitting the document. You can use a thick marker or white out pen to remove the information.
- Take a photo (jpg file) or a scan (PDF file) of the document.
- Use your personal (not work) email to scan or send documents to protect sensitive information from public records requests.
See the examples below. As shown, on your tax form, you can mark out all personal information except names, address, and filing status. On a bank statement or auto insurance policy, you could mark out any financial information and just keep the names and addresses.
Documents for a Spouse or Domestic Partner
| Change Needed | Verification Documents Required |
|---|---|
| Add a spouse with whom you live (husband or wife) | Option 1: Current or previous year’s federal tax return (first page only) Option 2: Marriage certificate and 2 joint financial statements within past 60 days* Option 3 (for those married within the past year): Marriage certificate |
| Add a spouse who lives separately (husband or wife) | Option 1: Current or previous year’s federal tax return (first page only) if filing jointly or both tax returns if filing separately, showing married status with spouse’s name Option 2: Marriage certificate and 2 joint financial statements within past 60 days* |
| Add a domestic partner | Affidavit of Domestic Partnership and 2 joint financial statements within past 60 days* |
| Add or remove a spouse or domestic partner who has lost or gained their medical or dental coverage | Copy of COBRA notice, insurance provider notice, or letter from employer on letterhead including name(s) of those losing or gaining coverage, date coverage ends or starts, and type of coverage |
| Remove a spouse due to divorce | Copy of divorce decree |
| Remove a domestic partner due to the relationship ending | Termination Statement of Domestic Partnership |
| Remove a spouse or domestic partner who died | Copy of death certificate |
Documents for a Child
| Change Needed | Verification Documents Required |
|---|---|
| Add a biological child* | Birth certificate |
| Add a stepchild* | Option 1: Birth certificate and Current or previous year’s federal tax return Option 2: Birth certificate, marriage certificate, and 2 joint financial statements within past 60 days** |
| Add a domestic partner’s child* | Birth certificate, Affidavit of Domestic Partnership, and 2 joint financial statements within past 60 days** |
| Add an adopted child* | Birth certificate or court/state issued adoption agreement |
| Add a grandbaby (under 18 months, parent is your dependent)* | Birth certificate showing covered dependent as parent |
| Add a foster child* | Court document showing employee and/or spouse listed as foster parent |
| Add another type of child (e.g. grandchild, niece, brother)* | Court order for guardianship or legal custody, and Current or previous year’s federal tax return (first page only) with child listed as a dependent |
| Add a child who has lost their medical or dental coverage* | Copy of COBRA notice and letter from employer on letterhead including name(s) of those losing coverage, date coverage ends, and type of coverage lost |
| Add a child over age 26 with a disability | Birth certificate or court/state issued adoption agreement |
| Add a child age 26 through 30 without a disability (at full premium cost) | Birth certificate and Over-Age Dependent Child Affidavit |
| Remove a child who has gained medical or dental coverage elsewhere | Copy of insurance provider notice or letter from employer on letterhead including name(s) of those gaining coverage, date coverage starts, and type of coverage |
| Remove a child who is no longer legally eligible for coverage *** | Court document |
| Remove a child who died | Copy of death certificate |
** Examples of joint financial statements are a bank statement, credit card bill, auto loan statement, mortgage statement, utility bill, and automobile registration.
*** You do not need to submit documents for a child who is no longer eligible due to their age as they will be automatically removed.
Where to Find the Documents
If you don’t have the documents at home, you can obtain them using the instructions below. Be sure to allow adequate time since some records are only available through the U.S. mail.
- Birth certificate: View a directory of vital records offices at the National Center for Health Statistics. Select the state where the child was born to view the address to submit your request and the cost.
- Federal tax return: Visit the IRS website to get a copy of a previous tax return which is called a transcript. The fastest way is to select Get transcript online. Other options found on the webpage are to request it by mail or by phone at (800) 908-9946.
- Joint financial statements from past 2 months: Examples are a bank statement, credit card bill, auto loan statement, mortgage statement, utility bill, and automobile registration. The 2 statements need to have both of your names at the same address and be from different institutions or from different accounts in the same institution and be dated within the past 60 days. You can go to the bank or company website, search for recent statements, and select Print > Save as PDF for a digital file or take a photo of the document on your computer screen, as long as the photo is legible. You only need to provide the first page.
- Court records: For court records such as letters of guardianship, go to the issuing court’s website. If it is a local court, see Pinellas County Court Records, Hillsborough County Court Records, and Pasco County Court Records. For other courts, search online for their record request process (e.g. go to Google and type Frederick County Maryland court record request).
Where to Submit Documents
Submit documents to Employee Benefits by mail, fax, or email. Please be sure to remove Social Security numbers and other sensitive information first.
- Mail: Pinellas County Human Resources Employee Benefits, 400 South Fort Harrison Avenue, 1st Floor, Clearwater, FL 33756
- Fax: (727) 453-3573
- Email: employee.benefits@pinellas.gov
Questions? Call Employee Benefits at (727) 464-3367, option 1.
2/7/25