Get Depaul University Human Resources Second Domiciled Adult ...

This guide provides step-by-step instructions for completing the DePaul University Human Resources Second Domiciled Adult Affidavit of Eligibility online. This form enables employees to establish eligibility for benefits for their second domiciled adults and their children.

Follow the steps to successfully complete the affidavit online.

1. Click the 'Get Form' button to obtain the affidavit and open it in the editor.
2. Fill in the name of the employee and the name of the adult for whom you are establishing eligibility. Ensure accuracy as this information is crucial for processing.
3. Select the appropriate relationship status by checking one of the options: Unrelated Second Domiciled Adult, Civil Union Spouse, or Related Second Domiciled Adult. If choosing Related Second Domiciled Adult, indicate the specific relationship.
4. Provide the second domiciled adult's date of birth in the specified fields.
5. If you wish to cover your second domiciled adult’s children, list their names, dates of birth, social security numbers, and genders in the designated sections.
6. Review the criteria for eligibility regarding both unrelated and related second domiciled adults. Ensure that all conditions are met before proceeding.
7. Indicate your request for health plan coverage by marking 'Yes' or 'No' for medical, dental, vision, and dependent life for both the second domiciled adult and their children.
8. For dependent life coverage options, select your preferred coverage amounts as indicated in the form.
9. Affirm and sign the affidavit, ensuring that all assertions made are true to your knowledge. Include your employee ID number.
10. Save your changes. You can now download, print, or share the completed affidavit as needed.

Complete your DePaul University Human Resources Second Domiciled Adult Affidavit of Eligibility online today.