Duke verifies the eligibility of all dependents covered by one of Duke's health plans to ensure compliance with plan provisions and the appropriate payment of legitimate health claims. This process is part of Duke's continued efforts to manage the increasing cost of health care.
While ineligible participants are often oversights based on changing family status such as divorce, the collective cost to Duke can represent millions of dollars.
All employees and retirees covering a dependent on Duke's health plans are included. Eligible dependents should only include:
- Your legal spouse or same-sex spousal equivalent,
- Your dependent children (includes natural children, stepchildren, adopted children, foster children, or children for whom you are legal guardian) up to the 26th birthday. Legal custody is not sufficient.
Proof of eligibility will differ depending on each type of dependent. It can be faxed to 919-668-6768, mailed to Box 90496, Durham, NC 27705, or emailed to email@example.com.
- Spouses may submit a copy of pages 1 and 2 of the most recent Federal tax return (with income information redacted). Page 2 must include signatures or an e-file confirmation page that contains the filing number. As an alternative to a tax return, spouses may submit a marriage certificate and proof of joint residency. Any information on those documents not relevant to the verification can be removed.
- Same-sex spousal equivalents: may submit a copy of the Duke affidavit and one other proof of joint residency.
- Dependent children must have a birth certificate showing a Duke employee or their spouse as a parent (marriage documentation required if the employee is not on the birth certificate).
- Other documentation will be required for step, adopted, foster children, children for whom an employee has legal guardianship or children of same-sex spousal equivalents.
All measures are being taken to ensure the confidentiality of personal data.
All employees covering dependents on Duke's health plans are required to submit verification of eligibility. If eligibility is not verified, the dependents will be removed from the health plan effective sixty days from the date of request.
Frequently Asked Questions
Why is Duke undergoing this initiative?
Conducting a dependent eligibility review is a best practice to keep health plan premium increases as low as possible by assuring all dependents on the health plan meet the plan's eligibility guidelines. In addition, the ACA requires employers to request the Social Security numbers of their employees covered dependents; this initiative is a means for Duke to ensure compliance with this ACA requirement.
What documents are needed?
The copy of the documents needed will vary based on the relationship of your dependent family member. For example, for a spouse you can submit a copy of your most recent income tax form that was submitted to the IRS, or for your biologic child, you can send a copy of your child's birth certificate.
Do I need to send originals?
No. Please do not send originals, only copies.
Can I redact or cross out information on the copy of the documents that I'm submitting?
Yes, not all information on the document is needed to demonstrate your family member's eligibility. For example, no income information is needed if you submit a copy of an income tax form to demonstrate your spouse's eligibility.
If there is information you are uncomfortable sending that is unrelated to demonstrating your dependent's eligibility for health plan coverage you can mark it out on the copy you send. If you have a question regarding whether the field is necessary on any copy you are submitting, please call the HRIC at 919-684-5600 weekdays from 8 a.m. 5 p.m.
Do I need to send any medical records?
Where do I send copies of my dependent's documents?
There are several options:
- You can mail, email (firstname.lastname@example.org), or fax (919-668-6768 the copies directly to the HRIC.
- You can bring copies of the documents to the Duke Human Resource's office at 705 Broad Street weekdays from 8 a.m. – 5 p.m.
Who qualifies as an eligible dependent?
The following dependents are eligible for enrollment in a Duke Health Care Plan:
- Your legal spouse or same-sex spousal equivalent,
- Your dependent children (includes natural children, stepchildren, adopted children, foster children, or children for whom you are legal guardian) up to the 26th birthday.
In order to continue coverage of a intellectually or physically disabled dependent child beyond the 26th birthday, all of the following criteria must be met:
- The parent must apply for the waiver on or prior to the child's 26th birthday;
- The mental or physical disability must be significant and render the child incapable of independent living and self-sustaining employment, and must be supported by medical records;
- The condition must exist on or prior to the 26th birthday;
- The parent must remain eligible;
- The parent must provide annual evidence of continued disability;
- There must not be a break in coverage after the 26th birthday under the parental policy.
What should I do if I realize I'm covering an ineligible dependent?
Contact the HRIC at 919-684-5600 to remove the dependent.
What is required on a valid state issued marriage certificate?
A valid state issued marriage certificate is received after the date of the ceremony and shows the following information: 1. A state issued recorded or file date; this may appear as either a Book No., Register No., State File No., County No., Certified and sealed date stamped, recorded or microfilmed date stamped; 2. An official signature of a judge, deputy clerk, or recorder; 3. The employee's name, spouse's name and marriage date.
What is proof of joint residency?
Proof of joint residency is a validation of the continued commitment of your marital or same-sex domestic partner relationship. Valid forms of proof of joint residency for the verification include:
- Joint statement: listing both you and your spouse/same-sex domestic partner, matching the address you have on file with Duke, and dated on or after April 1, 2016 (financial and account information may be marked out); or two statements with one name on each sent to the same address and dated within the last three months. No cell phone bills..
- Current lease agreement: listing both you and your spouse/same-sex domestic partner, matching the address you have on file with Duke, and dated within the last three months. It must include your signatures as well as the lessor/landlord signature(s) (documents with terms ending in excess of 90 days ago will not be accepted).
- Utility bills: listing both you and your spouse/same-sex domestic partner, matching the address you have on file with Duke and dated on or after the last three months.
Do not send a cellphone bill or any type of envelope as proof of joint ownership.
How can I obtain lost documents required to prove my dependent's eligibility status?
You may contact the government office in the county or state in which the event took place (i.e., birth, marriage, etc.). Most offices will mail a replacement document within five business days for a nominal fee. For a more immediate response, you may visit the county or state office to obtain the document the same day. Please make sure you know what information you will need to present in order to obtain the document prior to visiting the county or state office. You may also obtain documents online by visiting www.vitalchek.com. This web site is used by every U.S. state to process vital record requests and also has links to sites where you can request vital records from foreign countries or for American citizens born abroad. The average turnaround time for requests is three days, and requested documents are marked with the clerk of courts seal.
What if my documents are from the state of Idaho or Wisconsin?
If your dependent was born in the state of Idaho or Wisconsin or you were married in the state of Idaho or Wisconsin, you are required to submit a certified copy of the vital record.
Can I add or remove a dependent who is currently eligible for coverage under the Duke Health Care Plan?
No. The purpose of this project is to remove only ineligible dependents. Adding or removing dependents from coverage is allowed only during the annual enrollment period, or within 30 days of certain "life events" which change your status.
How will my personal information be used and who will have access to it?
Only Duke Human Resources will have access to your personal information, which will be used solely to verify the eligibility of your dependent(s). All transmitted information will be treated as private and confidential. Administrative, physical, and technological safeguards have been put in place to ensure the confidentiality of your personal information.
Who should I contact if I have additional questions?
Please contact the HRIC at 919-684-5600 Monday through Friday from 8 a.m. to 5 p.m.