OEAI Dependent

• OEAI Enrollment Application & Affidavit (CS-1833)

AND

Any of the four documents below, establishing the relationship between the OEAI and the OEAI dependent(s) you wish to enroll:

• Birth Certificate (hospital verifications not accepted)

• Adoption Papers or sworn statement with the date of placement

• Court Document placing the child in the employee’s home for foster care

• Court-Ordered Letters of Guardianship

Note: Dependent children of an OEAI may enroll in health insurance only up to their 26th birthday with a CS-1833 and the same required documentation that applies to equivalent dependent children of employees. Coverage will terminate at the end of the month in which the dependent turns 26.