REQUIRED DOCUMENTATION FOR THE CHEIBA TRUST
MEDICAL, DENTAL, LIFE AND VISION INSURANCE
LEGAL SPOUSE / COMMONLAW SPOUSE / DOMESTIC PARTNERSHIP /
CHILDREN


The eligibility documentation must be provided within the following time frames:
Within 31 days of benefits-eligibility, or
During the annual Open Enrollment period as scheduled by the member
institutions for benefit changes effective the following January 1st, or
Within 31 days of all changes related to IRS-defined change of status, or
Within 31 days of benefits changes due to meeting the criteria to establish a
domestic partnership as defined by the CHEIBA Trust.

Legal Spouse:
 Registered copy of marriage certificate
AND
 A document dated within the last 60 days showing current relationship status, such as a
monthly or quarterly household bill or statement of account. The document must list
your spouse’s name, the date, and your mailing address OR the first page and signature
page of your most recent federal tax return.


Commonlaw Spouse:
 Common‐law marriage affidavit
AND
 A document dated within the last 60 days showing current relationship status such as a
monthly or quarterly household bill or statement of account. The document must list
your spouse’s name, the date, and your mailing address.


Domestic Partnership (DP):
 The CHEIBA Trust Affidavit of Domestic Partnership and required supporting
documentation as outlined by the CHEIBA Trust.


Children:
 The child’s birth or adoption certificate, naming you or your spouse/DP as
the child’s parent, or appropriate custody or allocation of parental responsibility
documents naming you or your spouse/DP as the responsible party to provide
insurance for the child.
 Newborns – The registered birth certificate must be provided within 31 days of birth.
Social Security number must be provided within 90 days of birth.
The employee must provide a certified and notarized translation of any documents
presented which are in a foreign language.

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