Dependent Qualification Affidavit
There is no longer a Dependent Qualification Affidavit for eligibility in the PEIA plans. In order to substantiate eligibility for a dependent, you must submit one of the following documents:
biological child or stepchild (birth certificate),
adopted child (adoption papers) and
other child (court-ordered guardianship papers). If you cannot provide one of these documents, then the child is not eligible to be enrolled on your PEIA coverage.