HWPlan.org - UFCW 227 & Employers Health & Welfare Plan

Required Documentation for

Eligible Dependents

Who is an eligible dependent?

Per Plan rules, dependents include a member’s lawful spouse and each child of a member until the last day of the month in which the child attains age 26. The child must be a natural child, a legally adopted child or a child placed for adoption. Step-children are not eligible for coverage through the Plan unless you covered your stepchild on the Plan prior to December 31, 2010 and they have been continuously enrolled since that time.

What coverage is available for my dependents?

Dependent coverage is determined by your employment status, hire date and months enrolled in the Plan. This is general information - please see your benefit guide for more detailed information regarding your specific options.

Children (medical, prescription, vision, dental, life insurance)

Children (medical, prescription, vision, dental, life insurance)
Spouse (medical, prescription, vision, dental, life insurance)

Required documentation

Documentation must be submitted within 60 days of your enrollment to enroll dependents. For Annual Enrollment, it must be received by February 28, 2020. If you do not provide the requested dependent documentation by your deadline, you will not have an opportunity to add these dependents to the Plan until the next Annual Enrollment period (Fall 2020 for coverage January 1, 2021) unless a Qualifying Life Event as outlined in the Notice of Special Enrollment Rights occurs.

The items below are the minimum required documentation needed to cover a dependent.
The Plan Office reserves the right to require additional documentation if needed.


  • Provide a copy of the child’s state-issued birth certificate or legal adoption papers. The birth certificate must be mailed or uploaded through the MemberXG Document Center. Faxed copies will not be accepted.

  • If your child is greater than 60 days old, you must also provide your child’s social security number.


  • Provide a copy of the marriage certificate, your spouse’s social security number AND documentation dated within the last 60 days establishing current relationship status such as a joint household bill, joint bank/credit card account, joint mortgage/lease, or insurance policies. This document must list your name and your spouse’s name, the date, and your mailing address. You may mark out any other personal information that is not required.


  • If your spouse is eligible to be covered by his/her employer’s medical plan, your spouse must enroll in that plan, and coverage in this Plan will be secondary. The Plan rules currently state that if your spouse is eligible but does not enroll in his/her employer’s plan, you cannot enroll your spouse for coverage under the Plan.

  • If your spouse is employed, but is not eligible for health coverage through their employer, you are required to submit a letter from their employer, dated and on company letterhead, stating why they are not eligible to enroll in group health coverage.

  • If your spouse is not employed, you must choose the Not Employed option in the Spouse's Employment & Other Medical Plan Coverage section of your online enrollment.