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Proof of Eligibility Requirements
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MCHCP requires proof of eligibility* for all dependents added to
your coverage. Enrollment on dependent(s) is not complete until
proof of eligibility is received by MCHCP. Required documentation
should accompany the Change/Cancellation
(M-2) form. If you are a new employee, proof of eligibility
should be sent after completing your enrollment through SEBES.
You should include your MCHCPid or Social Security number on the
documentation. If proof of eligibility is not provided, a letter
will be sent requesting it. Documentation must be received within
30 days of the date of the letter or your dependents will
not be added. They are not eligible for coverage until the next
Open Enrollment period except in the case of a life event.
Documentation is also required in the event of death or divorce.
Proof of eligibility documents are kept on file for future reference.
Circumstance |
Documentation |
| Addition or Birth of dependent(s) |
Birth certificate* or
Hospital certificate
Subscriber
must be listed as parent. |
| Addition of step-child(ren) |
Marriage license* to biological parent of child(ren) and
birth* or hospital certificate for child(ren) that names the
subscriber’s spouse as a parent |
| Addition of foster-child(ren) |
Placement papers in subscriber’s care |
| Adoption of dependent(s) |
Adoption papers
or
placement papers |
| Legal guardianship of dependent(s) |
Court-documented guardianship papers (Power of Attorney is
not acceptable) |
| Newborn of covered dependent |
Birth certificate* for subscriber’s child(ren)
and birth certificate* for subscriber’s grandchild(ren) |
| Marriage |
Marriage license+
Marriage certificate or
Newspaper notice of the wedding |
| Divorce |
Final divorce decree or
Notarized letter from spouse stating he/she is agreeable to
termination of coverage pending divorce |
| Death |
Death certificate* |
*Copies of birth and death certificates filed in Missouri can
be obtained from the Missouri Department of Health and Senior Services.
+Copies of marriage licenses filed and divorce decrees granted in
Missouri can be obtained from the Recorder of Deeds or Circuit Clerk,
respectively, in the county where the event occurred.
Coverage is effective the first of the month following or coinciding
with the receipt of your enrollment, you must also provide proof
of eligibility for dependents.* Enrollment must be received within
a specific time frame.
Change/Cancellation (M-2)
form and proof of eligibility (if required) must be sent to MCHCP’s
form fax line at 866.346.8785 or mailed to:
MCHCP
PO Box 104355
Jefferson City, MO 65110-4355
Do not give the Change/Cancellation
(M-2) form to your Human Resource/Payroll office.
Enrollment Tips
New Employee: Enroll within
31 days of employment.
Life Events (birth, marriage or adoption):
Enroll within 31 days of event.
Loss of Coverage: Enroll within
60 days of loss.
COBRA Coverage: Enroll within
60 days of qualifying event.
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