Eligibility Requirements
Acceptable Supporting Documentation
SUBMIT TWO DOCUMENTS - Submit a copy of one document from PROOF A AND one document from PROOF B:
SPOUSE Your legal spouse (same or opposite sex)
PROOF A: (to show event occurred) Valid legal or religious marriage certificate, which must include: o Name of the employee and spouse o Date of marriage o Certifier’s signature/official seal Presently valid state-issued certificate, declaration or registration of common law or informal marriage (in applicable states) which must include: o Name of the employee and spouse o Date of informal marriage o Certifier’s signature/official seal Legal household/family registry, must show spousal relationship ( This is only acceptable if you were married outside the U.S. and do not have a marriage certificate.) AND PROOF B: (to show current relationship status) (Employees married within the last 12 months do not need to provide Proof B. ) Your Federal 1040 or State income tax return, which must: o Be from current or previous tax year o Contain name of employee and spouse o Indicate married filing jointly or married filing separately (Only the page listing filing status and exemptions is required-see sample. E-Files are not accepted.) Utility bill, which must: o Be dated within the last 12 months o Contain name of employee and spouse as joint owners o Contain name of utility company Document from a bank account or financial institution, which must: o Be dated within the last 12 months o Contain name of employee and spouse as joint owners of the account o Contain name of financial institution Insurance document such as homeowner, renter or automobile, which must: o Be dated within the last 12 months o Show employee and spouse as joint account owners (Individuals listed as “drivers” on automobile insurance documents do not prove joint account ownership) o Contain name of insurance company Mortgage document or current lease, which must: o Be dated within the last 12 months o Contain name of employee and spouse as joint owners or joint renters o Contain name of mortgage company, landlord or rental company Valid vehicle registration, which must: o Be dated within the last 12 months o Contain name of employee and spouse as joint owners o Contain name of state or county in which issued
Sample Federal 1040 Form
Please mark out SSN’s and Financial Info
Eligibility Requirements
Acceptable Supporting Documentation
SUBMIT ONE DOCUMENT- Submit a copy of one document from PROOF C:
Child under age 26 Your child(ren) until the end of the month they reach age 26 which includes: a biological child, a stepchild*, an adopted child or a child placed in your home for adoption, a foster child, or a child for whom you are the court-appointed legal guardian if that child is financially dependent on you.
PROOF C: Your Federal 1040 or State income tax return, which must: o Be from current or previous tax year o Contain the name of employee or spouse o List your dependent with the relationship as daughter, son or child (Only the page listing filing status and exemptions is required-see sample. E-Files are not accepted) Child’s legal or hospital birth certificate or affidavit of parentage, which must: o Contain the name of employee or spouse o Contain the name of the child o Indicate date of birth Legal household/family registry, must show relationship (This is only acceptable if the child was born outside the U.S. and you have no legal birth certificate.) Final divorce decree, parental custody agreement or Qualified Medical Child Support Order (QMCSO), which must: o Contain the name of the employee or spouse indicating parentage of the child o Contain the name of the child o Official signature or stamp indicating document has been filed Legal adoption, guardianship or legal custody papers, which must: o Contain the name of the employee or spouse o Contain the name of the child o Official signature or stamp indicating document has been filed *Also required to prove the relationship between you and your stepchild: If you are an employee providing documentation for a child of your legal spouse, Mercer must receive the required proofs listed for Spouse (Proof A and B), even if you do not currently cover your spouse.
Sample Federal 1040 Form
Please mark out SSN’s and Financial Info
Child age 26 and over Your child(ren) age 26 or over who meets the criteria for “child” listed above and is medically certified as disabled (prior to the child’s 26 th birthday), resides with you, and is primarily dependent upon your support.
SUBMIT TWO DOCUMENTS -Submit a copy of one document from PROOF C (above) AND one document from PROOF D:
PROOF D: Physician statement certifying that the dependent child: o Cannot support them self because of a physical or mental disability. o All information must be included on physician’s letterhead or form. *Also required to prove the relationship between you and your stepchild: If you are an employee providing documentation for a child of your legal spouse, Mercer must receive the required proofs listed for Spouse (Proof A and B), even if you do not currently cover your spouse.
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