Certification of Dependent Status form

Alerts

September 26, 2007
(Certification of Dependent Status Forms revised on 11/3/08)

Certification of Dependent Eligibility

Download Certification of Dependent Status form (Revised as of 11/3/08) in Word Format (must have Microsoft Word)

Download Certification of Dependent Status form (Revised as of 11/3/08) in Adobe Acrobat Format (Must have Adobe Acrobat)

Many group medical and dental plans contain definitions of “dependent” for purposes of coverage that differ from the definition of “dependent” found in the Working Family Tax Relief Act (WFTRA) for tax purposes.  Often times, the definition of “dependent” in the plan for purposes of coverage is dictated by state law.  When the definition in the plan differs from the WFTRA definition (even if it is required by state law), then the value of the coverage provided to any child who does not also meet the WFTRA definition of “dependent” must be included in the employee’s income.

This Certification may be used to identify whether children enrolled in your plan meet the WFTRA definition of “dependent.”  Based upon the information provided in the Certification, you will be able to determine whether there is a tax consequence to the employee of the coverage provided to the employee’s children.  If there is a tax consequence, it is the employer’s responsibility to either (1) require the employee to pay the value of the non-tax dependent’s coverage on an after-tax basis, or (2) to include that value in the employee’s income as the coverage is provided.

Note: Because it incorporates the definition of dependent contained in WFTRA, this Certification form should not be used for purposes of determining whether a child is entitled to coverage under your group medical and dental plans.

If you have any questions, please feel free to contact us.

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The information contained in this ALERT is intended for general information purposes only and does not constitute legal advice relative to a specific situation.