Need to Add a Dependent to Your Medical Plan?

If you are newly eligible under the Plan, recently married or have had a baby please follow these simple steps to add a dependent to your coverage:

1.) Complete the Fund's
census/beneficiary card
(be sure to complete both sides
and sign and date the card);

2.) Complete an election form;

3.) Supply a copy of a marriage
certificate when adding a
spouse;

4.) Supply a copy of the
state birth certificate naming
both parents when adding a
child.

The following may also be required when adding a child:

Qualified Medical Child Support
Order, Custody Order, Current
1040 Tax Form.

•Proof of adoption for any
adopted child or a child in the
process of being adopted.

•Proof of full time attendance at
an accredited secondary
school for any child over 18
and under 23. Acceptable
documentation includes:
Letter from school
principal confirming full
time attendance;

•Letter from registrar's
office confirming full time
attendance at an
accredited institution.

**PLEASE NOTE: Class schedules or proof of tuition payment are
NOT acceptable as proof of full time student status.

If you have any questions or are still unsure of what you need to supply, please contact the Funds Office at 215-568-3262 or 1-800-338-9025 if you are outside the area so one of our customer service representatives can assist you.