Domestic Partnership

You may cover your same or opposite sex domestic partner as your dependent for the purpose of health insurance coverage. A domestic partnership, for eligibility under the plan, is one in which you and your partner are 18 years of age or older, unmarried and not related in a way that would bar marriage. You must be living together, involved in a lifetime relationship and financially interdependent. At the time of application, you must have been in the partnership for six months.

You must submit a total of three (3) separate types of proof, one (1) proof of Cohabitation Duration and two (2) proofs of Financial Interdependence.

Please submit clearly unaltered original documents and one copy of the original documents. The original documents will be returned to you.

Proof of Six Months Cohabitation

You must submit one (1) proof that you and your partner have resided together for at least six months. The proof may be one document with both names or two separate documents that show the residence of each partner. The following are some of the items that can be used:

Auto registration, bank statement, driver's license, mailed insurance benefits statement, mailed joint membership statement with address, lease agreement listing both parties, a mortgage agreement including both parties, passport, pay check stub, tax return, telephone bill, utility bill.

Proof of Financial Interdependence

You must submit two (2) proofs of financial interdependence of at least six month duration. Below is a list of acceptable proofs (at least one of the two items must be from List A).

List A

Joint obligation on a loan, Joint ownership of your residence, Joint renter's or home owners' insurance policy, Joint responsibility for child care, Joint ownership of lease or motor vehicle, joint ownership or holding of investments, mutually granted durable power of attorney, both listed as tenants on the lease of shared residence, mutually granted authority to make health care decisions-i.e. health care power of attorney, shared a household budget for the purpose of receiving government benefits.

List B

Joint bank account, joint credit or charge card (s), status as authorized on the partner's bank account, credit card or charge card, other proof establishing economic interdependence.

The application will need to be signed by a Notary.

For a Domestic Partnership packet, please send an email to Edmond Anderson. The email should have your title and mailing address.


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