Adding Family Members

Chesapeake Public Schools requires the following documentation to verify eligibility for all insured dependents.

Spouses

All three (3) documents listed below are required to verify spouse eligibility.

  • City/court Certified Marriage Certificate (not the one from the clergyman)
  • A copy of the first page of last year’s or current year’s Federal Tax Return (Form 1040) showing married filing joint or married filing separately.  Your spouse’s name and social security number must be visible.  Please black out all financial information.
  • Joint Financial Document or statement from a financial institution such as a bank, credit union, or mortgage company dated within the last 60 days.  It must list your name and your spouse’s name, the date, and your mailing address.  Examples allowed include checking, savings, credit card, personal loan, or mortgage accounts.  Please black out all financial information.

Newborn babies

  • Proof of Birth Letter from the hospital within 31 calendar days of the baby’s birthdate for a temporary enrollment.
    and
  • State-Certified Birth Certificate and Social Security Number within 45 calendar days from the baby’s birthdate to complete their enrollment.

Children under 18

  • Birth or Adoption Certificate naming you or your spouse* as the child’s birth or adoptive parent.
    or Court Order naming you or your spouse* as the child’s legal guardian.

Children age 18 to 26

  • Birth or Adoption Certificate naming you or your spouse* as the child’s birth or adoptive parent.
    or Court Order naming you or your spouse* as the child’s legal guardian.
    and
  • Federal Tax Return (Form 1040) showing you claim the dependent.  Custodial children, age 18 to 26, must be listed on the current year’s tax return.

Disabled children over 26

  • Birth or Adoption Certificate naming you or your spouse* as the child’s birth or adoptive parent.
    or Court Order naming you or your spouse* as the child’s legal guardian.
    and
  • Federal Tax Return (Form 1040) showing you claim the dependent.  Custodial children, age 18 to 26, must be listed on the current year’s tax return.
    and
  • Anthem Handicapped Dependent Certification completed by a physician and submitted with enrollment paperwork. Please Email Employee Benefits to request form.

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*If you are not the child’s named parent or guardian, all four (4) forms of the documentation listed for a spouse will also be required.