MCHCP requires proof of eligibility for all dependents added to coverage. Include proof of eligibility with enrollment request. Enrollment of dependents is not complete until proof of eligibility is received by MCHCP. Include the subscriber’s MCHCPid or Social Security number on the documentation.
Acceptable forms of proof of eligibility are listed below.
|Enrollment||Addition of biological child||Government-issued birth certificate or other government-issued or legally certified proof of paternity listing subscriber as parent and child’s full name and birth date|
|Addition of child of a covered dependent||Government-issued birth certificate or legally-certified proof of paternity for the child listing dependent as parent with child’s full name and birth date|
|Addition of foster child||Order of placement|
|Addition of stepchild||Marriage license to biological or legal parent/guardian of child; and government-issued birth certificate or other government-issued or legally certified proof of eligibility for child that names the subscriber’s spouse as a parent or guardian and child’s full name and birth date|
|Adoption of dependent||Order of placement; or
Filed petition for adoption listing subscriber as adoptive parent (documentation must be received with the enrollment forms) and final adoption decree or a birth certificate issued (documentation must be received within 31 days of the date the court enters a final decree of adoption).
|Legal guardianship or legal custody of dependent||Court-documented guardianship or custody papers (Power of Attorney is not acceptable)|
|Loss of MO HealthNet or Medicaid||Letter from MO HealthNet or Medicaid stating who is covered and the date coverage terminates|
|Loss of Prior Group Coverage||Letter from previous insurance carrier or former employer stating date coverage terminated, length of coverage, reason for coverage termination, and list of persons covered|
|Marriage||Marriage license or certificate recognized by Missouri law|
|MO HealthNet Premium Assistance||Letter from MO HealthNet or Medicaid stating member is eligible for the premium assistance program|
|Qualified Medical Child Support Order||Qualified Medical Child Support Order|
|TRICARE Supplemental Coverage||Military ID Card|
|Termination||Delete a dependent due to divorce||Final divorce decree; or
Notarized letter from spouse stating agreement to termination of coverage pending divorce or legal separation
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