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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