Domestic Partner Insurance Form

Please refer to the secretary of state s website at.

Domestic partner insurance form. We affirm that this domestic partnership began on or about. For civil union partners a copy of the certificate issued by the state of hawaii department of health must be attached to the enrollment application and. Employee print name domestic partner print name certify and declare that we are domestic partners in accordance with the following criteria. An enrollment application with the eutf in the form prescribed by the eutf board of trustees and for domestic partners a declaration of domestic partnership in the form prescribed by the eutf board of trustees or.

We are each other s sole domestic partner and we intend to remain so indefinitely. In order to enroll a domestic partner or civil union partner the employee beneficiary must file the following forms. A child s continued eligibility for fehb fedvip coverage as a stepchild who is the child of a same sex domestic partner must be determined on an annual basis at open season. Domestic partner insurance or domestic partner health insurance is when an insurance contract extends the definition of spouse to recognize domestic partners.

Either domestic partner may inform the employing agency or retirement system of the dissolution of the domestic partnership. The domestic partners registry registers same sex couples regardless of the age of the partners and opposite sex couples in which one partner is at least 62 years old as domestic partners in california when they file a declaration of domestic partnership. Our interdependence is demonstrated by completion of section a or b below. Domestic partnership agreements provide a way for unmarried couples to define financial health and end of life agreements.

Form ps 425 1 application for enrolling domestic partners and affidavit of domestic partnership in the new york state health insurance program nyship with supporting documentation as noted on the form form ps 425 3 nyship dependent tax affidavit photocopy of your domestic partner s birth certificate photocopy of your domestic partner s social security card photocopy of your domestic partner s medicare card if applicable photocopy of your divorce decree if applicable. You may have to sign a form available from your health insurance administrator. Proof of domestic partnership. We provide domestic agreement forms often called living together contracts.

Please check this item and attach a copy of the documentation if you and your domestic partner have a government issued domestic partner certificate or its equivalent issued by a state or municipal government b.