SPD: Benefits: Dependent Eligibility Verification Audit

The state of Indiana has instituted a process to verify the dependents enrolled and previously enrolled on the state’s health, dental and vision plan(s). Therefore, employees are randomly selected to participate in a dependent audit. The audit helps ensure that dependents enrolled are eligible and helps keep costs down.

Read the standardized policy on Dependent Eligibility Verification Audits.

Once documents are requested, submissions may be sent to:

Indiana State Personnel
Attn: Dependent Audit
402 W Washington St. RM W-161
Indianapolis, IN 46204

Fax: 317-232-3011

Email: deva@spd.in.gov
Please send by encrypted email only.

Any questions concerning the dependent audit should be directed to the SPD Benefits Hotline at 317-232-1167 or toll-free at 877-248-0007.

Eligibility Definition and Required Documentation

Dependents	Eligibility Definition	Documentation Required
Spouse	An individual to whom you are legally married. IC 31-11-8-5 provides: a marriage is void if the marriage is a common law marriage that was entered into after Jan. 1, 1958. Employees are not allowed to claim dependents based on common law marriages. An ex-spouse is not eligible for coverage even if court ordered.	Photocopy of marriage certificate AND a copy of the front page of the employee’s most recent federal tax return that includes employee’s spouse (You may black out all financial information. Please leave all social security numbers visible.)
Child	Any children, step-children, foster children, legally adopted children of the employee or spouse, or children who reside in the employee’s home for whom the employee or spouse has been appointed legal guardian or awarded legal custody by a court, under the age of twenty-six (26). Such child shall remain a “dependent” for the entire calendar month during which he or she attains age twenty-six (26).	For Biological Child(ren) Photocopy of birth certificate showing employee’s name. If your last name is different on your child's birth certificate, we will need proof of you name change. For Stepchild(ren) Photocopy of the birth certificate showing employee’s spouse’s name; AND a copy of marriage certificate showing the employee and parent’s name, AND a copy of the front page of the most recent federal tax return showing the employee and parent's name. (You may black out all financial information. Please leave all social security numbers visible.) For Legal Guardian, Adoption or Foster Child(ren) Photocopy of Affidavits of Dependence, Final Court Order with presiding judge’s signature, Adoption Final. Decree with presiding judge’s signature or a Qualified Medical Child Support Order showing the date of birth.
Disabled Dependent	In the event a child: i.) was defined as a “dependent”, prior to age 19, and ii.) meets the following disability criteria, prior to age 19: (I) is incapable of self-sustaining employment by reason of mental or physical disability, (II) resides with the employee at least six (6) months of the year, and (III) receives 50% of his or her financial support from the parent such child’s eligibility for coverage shall continue, if satisfactory evidence of such disability and dependency is received by the State or its third party administrator in accordance with disabled dependent certification and recertification procedures. Eligibility for coverage of the “Dependent” will continue until the employee discontinues his coverage or the disability criteria is no longer met. A Dependent child of the employee who attained age 19 while covered under another Health Care policy and met the disability criteria specified above, is an eligible Dependent for enrollment so long as no break in Coverage longer than sixty-three (63) days has occurred immediately prior to enrollment.	Documentation as noted above for “Child” dependent type AND a copy of the employee’s most recent federal tax return showing the dependent listed (You may black out all financial information. Please leave all social security numbers visible.) Please note that this audit is only verifying the child’s eligibility as a “dependent.” Whether a dependent is “disabled” is outside the scope of this audit.

Dependents

Eligibility Definition

Documentation Required

Spouse

An individual to whom you are legally married. IC 31-11-8-5 provides: a marriage is void if the marriage is a common law marriage that was entered into after Jan. 1, 1958. Employees are not allowed to claim dependents based on common law marriages. An ex-spouse is not eligible for coverage even if court ordered.

Photocopy of marriage certificate
AND a copy of the front page of the employee’s most recent federal tax return that includes employee’s spouse (You may black out all financial information. Please leave all social security numbers visible.)

Child

Any children, step-children, foster children, legally adopted children of the employee or spouse, or children who reside in the employee’s home for whom the employee or spouse has been appointed legal guardian or awarded legal custody by a court, under the age of twenty-six (26). Such child shall remain a “dependent” for the entire calendar month during which he or she attains age twenty-six (26).

For Biological Child(ren)

Photocopy of birth certificate showing employee’s name.
If your last name is different on your child's birth certificate, we will need proof of you name change.

For Stepchild(ren)

Photocopy of the birth certificate showing employee’s spouse’s name;
AND a copy of marriage certificate showing the employee and parent’s name,
AND a copy of the front page of the most recent federal tax return showing the employee and parent's name. (You may black out all financial information. Please leave all social security numbers visible.)

For Legal Guardian, Adoption or
Foster Child(ren)

Photocopy of Affidavits of Dependence, Final Court Order with presiding judge’s signature, Adoption Final. Decree with presiding judge’s signature or a Qualified Medical Child Support Order showing the date of birth.

Disabled Dependent

In the event a child:

i.) was defined as a “dependent”, prior to age 19, and
ii.) meets the following disability criteria, prior to age 19:

(I) is incapable of self-sustaining employment by reason of mental or physical disability,
(II) resides with the employee at least six (6) months of the year, and
(III) receives 50% of his or her financial support from the parent

such child’s eligibility for coverage shall continue, if satisfactory evidence of such disability and dependency is received by the State or its third party administrator in accordance with disabled dependent certification and recertification procedures. Eligibility for coverage of the “Dependent” will continue until the employee discontinues his coverage or the disability criteria is no longer met. A Dependent child of the employee who attained age 19 while covered under another Health Care policy and met the disability criteria specified above, is an eligible Dependent for enrollment so long as no break in Coverage longer than sixty-three (63) days has occurred immediately prior to enrollment.

Documentation as noted above for “Child” dependent type
AND a copy of the employee’s most recent federal tax return showing the dependent listed (You may black out all financial information. Please leave all social security numbers visible.)

Please note that this audit is only verifying the child’s eligibility as a “dependent.” Whether a dependent is “disabled” is outside the scope of this audit.

Frequently Asked Questions

Q: Why are you asking me to verify my dependents?
A: We must guarantee consistent application of eligibility requirements within our health plans. Additionally, ineligible dependents that are using our health plans create higher costs for those who are eligible.

Q: Who is being audited?
A: Any employee who currently has or have had family health coverage will be subject to being randomly selected to comply with the Dependent Eligibility Verification Audit (or DEVA).

Q: Which dependent types must be verified?
A: All eligible dependent types (spouse, child, disabled child and ward) must be verified to maintain coverage for these eligible dependents.

Q: If I have misplaced my marriage certificate, birth certificate(s) or other documents needed for this audit, where can I get a new copy?
A: To obtain a copy of a marriage certificate you may contact the local courthouse in which the event took place to request a copy. Information on how to order a birth certificate can be found through the Department of Health at: www.in.gov/health/vital-records/order-now.

Q: What happens if I fail to respond to the Dependent Eligibility Verification Audit?
A: This audit is mandatory for all employees that are selected. If you do not provide the required documentation to verify your dependent(s) eligibility before the deadline, you will be subject to appropriate disciplinary action up to and including dismissal.

Q: Where do I send this documentation?
A: Required Documentation can be faxed to 317-232-3011, emailed to deva@spd.in.gov (Please send by encrypted email only), or mailed to:

Indiana State Personnel
Attn: Dependent Audit
402 W Washington St. RM W-161
Indianapolis, IN 46204

Q: I removed my spouse during open enrollment, why are they still being audited?
A: We are auditing dependents that have been covered under the state’s plans during the past two years. Because you were covering your spouse, documentation is still needed to insure eligibility for the covered time frame.