Dependent Verification Process:
Sample of Consova Dependent Eligibility Verification Request

April 18, 2018

Dependent Eligibility Verification
ACTION REQUIRED

Dear Participant,

As part of an operational excellence initiative to increase efficiencies and reduce costs, Southern California IBEW-NECA Health Trust Fund has retained the services of Consova Corporation ("Consova") to collect documentation to review and verify eligibility for dependents in the Trust Funds benefits.

This is not a passive verification process. Non-response or incomplete documentation will result in the termination of coverage for these dependents. Once your submitted documentation has been reviewed, Consova will mail a letter to you regarding the updated status and if any additional information is required.

If you have any questions about this process or need assistance, please call Consova's Dependent Eligibility Verification Assistance Center at 1-855- 864-9391 Monday through Friday, 7:00 a.m. – 3:00 p.m. Pacific Standard Time.

Dependent(s) you have included on Southern California IBEW-NECA Health Trust Fund sponsored health plans are listed below:

Dependent Name	Relationship	Birth Year
Michelle Smith	Spouse	1956
Jane Smith	Child	1995

Your Action Items

Review your list of dependents above and the detailed explanation of the documentation you will need to provide to verify eligibility for dependent(s) on the following pages.
If any of your dependents listed above are no longer eligible for coverage, please provide their names and the reason for ineligibility on the attached Ineligible Dependent Form. Coverage for the ineligible dependents will end as soon as administratively possible.
Upload documentation by logging into www.Consova.com/IBEWNECA, you will need your PIN number, which will be mailed to you, to log in to the website. You may instead mail copies of the documentation, no originals along with a copy of this letter in the enclosed postage-paid envelope with a postmark on or before May 16, 2018.

If you would like to receive Consova communications electronically, log into www.Consova.com/IBEWNECA and select Consova's "Going Green" option at the top of the page to learn more about our paperless option.

Thank you for your cooperation during this important initiative.

Sincerely,
Consova Corporation

Dependent Documentation Request - What You Need to Submit to Consova

Dependent Relationship	Required Verification Documents
Spouse Your legally married spouse (legally separated or divorced spouses are not eligible for coverage)	A certified copy of marriage certificate. AND A copy of your joint 2017 federal tax return or both of your tax returns if you file separately. Include the front page through line 6 of Form 1040. Please black out any financial information and the first 5 digits of the Social Security numbers.
Child under age 26 Your natural child, legally adopted child; Stepchild; A child whom you have legal guardianship of; or A child who is the subject of a Qualified Medical Child Support Order (QMCSO) issued to you.	A copy of the following documents (varies by the relationship of the child to the Participant): Natural child or legally adopted child: State or county issued birth certificate showing participant's name or signed court order. If birth certificate lists participant's maiden name, please provide marriage certificate. Stepchild: State or county issued birth certificate showing parents' names, copy of your Marriage Certificate, and copy of your joint 2017 federal tax return (front page only). Child whom you have legal guardianship: Signed Court Order and 2017 tax return claiming the child as a dependent. Child who is the subject of a Qualified Medical Child Support Order: Signed Court Order. Please note: for unmarried disabled children aged 26 or over, in addition to the birth certificate, we will also need a copy of your 2017 federal tax return claiming the child (front page only).

Dependent Relationship

Required Verification Documents

Spouse

Your legally married spouse

(legally separated or divorced spouses are not eligible for coverage)

A certified copy of marriage certificate.
AND

A copy of your joint 2017 federal tax return or both of your tax returns if you file separately. Include the front page through line 6 of Form 1040. Please black out any financial information and the first 5 digits of the Social Security numbers.

Child under age 26

Your natural child, legally adopted child;
Stepchild;
A child whom you have legal guardianship of; or
A child who is the subject of a Qualified Medical Child Support Order (QMCSO) issued to you.

A copy of the following documents (varies by the relationship of the child to the Participant):

Natural child or legally adopted child: State or county issued birth certificate showing participant's name or signed court order. If birth certificate lists participant's maiden name, please provide marriage certificate.
Stepchild: State or county issued birth certificate showing parents' names, copy of your Marriage Certificate, and copy of your joint 2017 federal tax return (front page only).
Child whom you have legal guardianship: Signed Court Order and 2017 tax return claiming the child as a dependent.
Child who is the subject of a Qualified Medical Child Support Order: Signed Court Order.

Please note: for unmarried disabled children aged 26 or over, in addition to the birth certificate, we will also need a copy of your 2017 federal tax return claiming the child (front page only).

If you are unable to provide any of the documents requested, the participant will need to contact Consova for alternative documents if applicable.

Don't Forget! Your response is required by May 16, 2018.

Completing Eligibility Verification is as easy as ...1,2,3

Login to the Secure Participant Portal
Visit www.Consova.com/IBEWNECA using any browser or mobile device.

TIPS & TRICKS:
You can scan the QR Code on the right for quick access to the portal.
Be sure to have your secure PIN handy (See page 1 of the audit packet)
Review & Confirm Documents
In the "Upload Documents" tab, upload the required documents to verify dependent eligibility. Only PDF, JPG, JPEG, GIF & TIF file formats are accepted.

TIPS & TRICKS:
You can scan the QR Code on the right for quick access to the portal.
Be sure to have your secure PIN handy (See page 1 of the audit packet).
Done...That Was Easy!
Once your documents have been uploaded, allow 3-5 days for processing.
We recommend checking back regularly to monitor your audit status.

Document Tips & Tricks:

Form 1040 Redacting
On page 1 of the Form 1040, Consova will need lines 1-6 to verify eligibility. For privacy, you can redact (black out) the first 5 digits of social security numbers and any reference to your income.

Marriage License
A marriage license only proves you filed for a license and is NOT an approved verification document.

Birth Certificate
For a birth certificate to be accepted, it must contain the parent(s) name and be issued by the county or state to prove relationship status.

Marriage Certificate
A certified marriage certificate proves you did get married and recorded with the county clerk’s office. This is an approved verification document.

<< Go Back

New Participant Portal

Dependent Verification Process:
Sample of Consova Dependent Eligibility Verification Request

Dependent Documentation Request - What You Need to Submit to Consova

Completing Eligibility Verification is as easy as ...1,2,3

Document Tips & Tricks:

New Participant Portal

New Participant Portal

Dependent Verification Process: Sample of Consova Dependent Eligibility Verification Request

Dependent Documentation Request - What You Need to Submit to Consova

Completing Eligibility Verification is as easy as ...1,2,3

Document Tips & Tricks:

New Participant Portal

Dependent Verification Process:
Sample of Consova Dependent Eligibility Verification Request