Get Recognized Child

Filling out the Recognized Child form is essential to verify dependent eligibility for health and dental coverage provided by the University of Rochester. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to effectively complete the Recognized Child form.

1. Click ‘Get Form’ button to access the form. This will allow you to open it in an editable format.
2. Begin by entering your details in the appropriate fields. Fill in your name, employee ID number, and phone number as indicated. Make sure to print clearly to avoid any miscommunication.
3. Input the recognized child's name and date of birth in the specified fields. Double-check the spelling of their name and ensure the date is accurate.
4. Indicate the recognized child’s relationship to you by selecting the correct option: grandchild, niece, nephew, or other child.
5. Review the definition of a recognized child provided at the top of the form and verify your eligibility based on the criteria specified.
6. Sign and date the form at the bottom to confirm your agreement and understanding of the information provided. This is a crucial step for the eligibility verification process.
7. Submit the completed form to the Benefits Office via the provided return options: in-person at the specified room, via fax, or through intramural mail.

Complete your Recognized Child form online today to ensure your dependent eligibility for health and dental coverage.