ffihms Deoendent

lrving,
Verification
PO Box165308
TX 75016-9923
R PC or Mobile Upload: https://www.VerifyOS.

ffi Fax.1-877-223-8478
J u n e2 6 , 2 0 1 8

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REFERENCENUMBER :
RESPONDBY: September10, 2018
Dea
The Universityof lowahascontracted enrolledin yourUlChoiceplanmeetthe
us to verifythatdependents
guidelines
eligibility for plancoverage. Makingsurethathealthplandependents areeligible to receive
healthcare benefitsis a commonpractice amongtheUl'speerinstitutions,
hasbeenrecommended by an
internalauditconducted by the university,
andis considereda best-practice
in thefield.lt will helpthei
universitykeepits benefitscompetitive by keepingdowncostsand bettercontrolling premiums, co-insurance,
andco-paylevels.
11ordelforyourdependent(s) to receivebenefits,
to continue action is requiredby you to submit proof of
theireligibilityto HMSby September'10,2A18.
UnderyourUlChoice
plan,eligible
dependents
aredefinedas:
. Yourlegalspouseof the oppositeor samesex
. Yourcommonlawspouseof theopposite or samesex
. Yourdomesticpartnerof the oppositeor samesex
. Yourchild*up to theendof theyearin whichtheyturnage26
. Yourchild*age26 or older,whois enrolled in an accredited
educational
institution
as a full{imestudent
. Yourdisableil
child*age26 or older,whois unmarried, claimedas a dependenton yourtax returnand
whois receivingbenefits
fromMedicare or thesocialsecurityadministration
dueto disability.

*A childis definedas your naturalchild;stepchildor domesticpartner'schild;legallyadoptedchildor child

placedin yourhomefor thepurposeof adoption;your fosterchild;your childfor whomyou havelegal
guardianship;or your naturalchildfor whoma courTordersto be covered.
A detailedlistof documentsrequired of yourcovereddependent(s)
to verifytheeligibility canbe foundon the
reversesideof thisletter.Copiesof the requireddocuments andthe enclosed
Verification
Formmustbe
returnedto HMSby September 10,2018.'
lf you havequestions
afterreadingthe attachedFrequently
AskedQuestions (FAQ),pleasefeelfreeto call
HMSat (877)318-7531 from7amto 7pmCentral Time,MondaythroughFriday.
Thankyoufor yourcooperation
withthisimportant plancosts.
effortto controlhealthcare

n
,,Espafrsl?
Paraasistenciaen espafiol,por favorcomuniquesecon HMSal
(877)318-7531.

(over)+
1
. R EQ U IREDDO CUME NTS
All requireddocuments MUSTcontain a date (includingyear),employeename,and dependent'sname.
Pleasedo not mail original documentsas they will not be returned.Mail onlv
nly copies your
copies of vour
documents.
documents.OnOn the documents,you may blockout personalinformation
requireddocuments,
the required such as Social
Securitynumbers,
Securitynumbers,account
accountnumbers,
numbers,and financial for purposes
financialinformation
information purposesof confidentiality.
confidentiality.
P
Please
includea signedand datedcopy of the enclosedVerificationFormwith all documentationsubmitted.
SPOUSEor GOMMONLAW SPOUSE:
o A copy of your marriagecertificate(callHMS if you are unableto obtaina copy of your marriage
certificate),
or a new,completedAffidavitof CommonLaw Marriage(downloadform on
www.verifyos.com).
o AND one of the following:
@fyo u r 2 o17federa|taxreturn(Fo rm1 0 4 0 )s h o win g y o u f i|e d a s ma rrie d o r
marriedfilingseparatelywith yourspouse.
- A documentdatedwithinthe last60 days,such as a recurringmonthlyutilitybill,creditcard bill,or
accountstatement. The documentmust be currentand listyourspouse'sname,your mailingaddress
and the date.Note:Healthcarebillswill not be acceptedas proofof eligibility as healthcare
Coverageis
beingverified.

DOMESTICPARTNER:
of a ner,y,
completed (download
Affidavitof Domestict'artnership formon www.verifyos.com).
) two of the followinqitems.A. B. C. D:
A. A copy of a mentshowingjointownershipof a residence(suchas home,condominium, or
mobilehomemortgagestatementor payofflor a leasefor a residenceshowingyou and your partneras
tenants.
B. Twoof the followino:
- Jointownership of a-motor vehicle- a copyof the purchase agreement, carloan,or carregistration
- Jointcheckingaccount- a copyof a recentstatement datedwithinthe past60 days
- Jointcreditcardaccount- a copyof a recentstatement datedwithinthe past60 days
1 A copyof a DurablePowerof Attorneyfor healthcare or financialmanagement withyourpartner
Q. A copy of yourlifeinsurance, will,or retirement
contract showing partneras a prim-ary
beneficiary.
D. A copyof yourrelationship contractwhichobligates eachof the partiesto providesupportfor the
otherpartyandprovides, in theeventof termination of therelationship,
for a substantially
equaldivision
of anyproperty acquired duringthe relationship.

CHI L D R E U
N PT O A GE2 6 :
o A copyof the child'sbirthcertificate,
hospitalbirthrecord,or adoptioncertificate
namingyou,your
spouse, or yourdomesticpartneras thechild'sparent,
. a copyof thecourtordernamingyouas thechild'slegalguardian (upto age18only),
o 98
OR a copyof a Qualified Medical ChildSupport Orderthatrequiresyouto covbryourchild.

CHILDREN AGE26 OR OLDER:(2)Two documentsrequired

o A copyof the child'sbirthcertificate, namingyou,your
hospitalbirthrecord,or adoptioncertificate
spouse,or yourdomestic partner as thechild'sparent,
" AND a copy of your child'sstudentschedulefor the Fall2018 semester/quarter
showingfull time
enrollmentin an accreditedcollegeor university.

DISABLEDCHILDRENAGE 26 OR OLDER:(3) Three documents required

o A copVof the child'sbirthcertificate,hospitalbirthrecord,or adoptioncertificatenamingyou, your
spouseor yourdomesticpartneras the child'sparent,
o AND a copyof yourfiled2017tax return(Form1040)listingyourchildas a tax dependent,
o AND a copyof your child'smostrecentMedicarestatementor SocialSecurityAdministration statement
showingyour childis receivingbenefitsdue to theirdisability.

Notefor Stepchildor DomesticPartner'sChild:If you are coveringa stepchildor partner'schild,you mustalso

providedocumentation of your currentrelationship
to the child'sparentas requestedabove.
 l
PLEASERETAINTHIS FAQ FOR YOUR REFERENCE

PleasesubmitALL REQUIRED DOCUMENTS AruDSIGNEDVERIFICATION FORMby September 10,

2018usinganyof thefollowingmethods(werecommend oneof thefirsttwooptionsfor fasterprocessing).
. Visitwww.VerifyOS.com anduploadyourdocumentsusinga computeror mobiledevice
. Submityourdocuments 24 hoursa day,7 daysa weekvia ourtoll-freefax at 1-877-223-8478
. Submityourdocuments (donotsendoriginaldocuments) viamailto: Dependent Verification,
P.O.Box165308, lrving,TX 75016-9923.
This checklistwill helpyou completethe verificationprocess:
n Keep your referencenumberthroughoutthe review in order to check your status online at
www.VerifyOS.com.
! Include
a COPYof theVerification
FormwithALL documentssubmitted.
! Ensureeachdocumentis a LEGIBLEBLACKand WHITECOPYof the document. Pleasenote:
documentssubmittedto HMSwillnotbe returned.
n WhenmailingpaperdocumentsDO NOTSTAPLEor HIGHLIGHT.

FREQUENTLYASKED QUESTIONS

Q1. Why is the University of lowa conducting a DependentEligibility Verification Program?

The Universityof lowa is sensitiveto the risingcostsof healthcarefor its employeesand feelsthis verification
programis necessaryto help make sure its healthbenefitplansare compliantwith statelaw,competitive,and
cost effective.This programalso helpsthe Universityof lowa manageoverallplan costs,which benefitsall
emproyees.

Q2. Who is HMS?

HMS is an independentthird-partywith whom the Universityof lowa has contractedto verifythe eligibilityof
dependents coveredunderits healthbenefitplans. HMS specializes in verifyinghealthplaneligibility
and has
reviewedverificationdocumentation for millionsof dependentsfor some of the largestemployersin the United
States. Experienceand expertiseare necessaryto completethis programaccuratelyand successfully, and to
limitinconvenienceto participants.

Q3. The documentation required contains sensitive information. ls this process secure?
Protectingpersonalinformationis a priorityto the Universityof lowa and HMS. In compliancewith applicable
U.S. (federal)and state regulations,
informationand documentation submittedto HMS for the Dependent
Verificationprogramis stored,processed,and protectedby physical,electronic,and procedural
Eligibility
safeguards.When submitting your tax documentation,only the top portion that includes the na'mesof
the employee,spouse, and any dependent child(ren) is required. Pleasemark out Social Security
Numbers, as well as any income information.

All documentsare securelystoredfor six monthsfollowingcompletionof the verificationprogram. Upon

expirationof the retentionperiod,all documentsand electronicfileswill be securelydestroyedby HMS,and a
Certificateof Destructionwill be suppliedto the Universityof lowa. P/ease note that documents provided will
NOTbe returned. HMS meetsall of the professional and legalstandardsassociatedwith providingserviceto
employers,includingthe HealthInsurancePortabilityand Accountability Act (HIPAA),EmployeeRetirement
IncomeSecurityAct (ERISA),and disposalrulesas enforcedby the FederalTradeCommission.In addition,
everyemployeeof HMS submitsto a thoroughand multi{ieredbackgroundcheck. Only HMS employees
directlyinvolvedin the Universityof lowa dependentverificationprogramwill have accessto thesedocuments.

Q4. Do I need to send original documents?

Pleasedo not send your original documents; a copy is sufficient.lf the documentis two-sidedor has multiple
pages,ensureyou copy all pagesand bothsidesof the paper.
Q5. Where do I go for more information regarding the DependentEligibility Verification program or go to
find out where I can obtain copies of the documents I need?
Visit us onlineat www.VerifyOS.comfor detailsregardingthe program,toolsio assistyou in locatingand
submittingyour documentation, and more.This securesite is compatiblewith your mobiledevice.

Q6. Where do I go to order a new copy of my marriage certificateor my child's birth certificate?
The HMS EmployeeWebsite,wvwv.VerifyQ$.com, has helpfullinksto onlineresources.Log onto the website
and navigateto the "ResourcesTAB" for assistance.

Q7. How will I know if my information has been accepted and my dependentsare verified?
Once your documentation has been receivedby HMS,you may checkthe statusof each of your dependentsby
loggingon to www.VerifyOS.com. In addition,you will receivea writtencommunication indicatingthat you have
completedthe dependentverificationprocessor if additionalinformationis needed. Ultimately,it is your
responsibility
to ensurethat your documentswere successfullyreceived.

Q8. What happens if I do not submit all required documents by the verification deadline?
lf you do not submitcompletedocumentation for your dependentsby the deadline,the effecteddependent(s)for
whom completedocumentation has not been submittedwill be removedfrom coverageeffectiveJanuary1,
2019.

Goingforward,if a covereddependentis foundto be ineligible,they will be removedfrom coverage.

The Universityof lowa is ultimatelyresponsiblefor determininghow best to handleeach individualcase.

Q9. May I provide my documents to University Benefits or my HR representative?

No. The Universityof lowa will not be able to forwardyour documentsto HMS or provideemployeeswith copies
of previouslysubmitteddocuments.The only way to ensurethat all documentsare loggedappropriately and the
of yourdependents
eligibility is verifiedis to submityoursupporting
documentation to HMS. Pleasedo not
contactUniversityBenefitswith questionsor for assistancewith the verificationprogram,as this is an
independent reviewbeingfullymanagedby HMS. lf you havequestions, you shouldcall HMS (877)318-7531
from 7:00a.m.- 7.00p.m.CentralTime,MondaythroughFriday.

Q10. Can an exception be granted to allow my ineligible dependentto stay covered?

No. Only dependentswho currentlysatisfythe plan'seligibilitydefinitioncan remaincovered.

becauseof a "qualifying
lf the dependentis no longereligible event,"(e.9.,divorce,childreachesage limit),see
your HumanResourcesrepresentative for COBRAdetails. COBRA,or the Consolidated OmnibusBudget
Act, givesworkersand theirfamilieswho lose their healthbenefitsthe rightto chooseto continue
Reconciliation
group healthbenefitsprovidedby theirgroup healthplan for limitedperiodsof time undercertaincircumstances.

Q11. I prefer email communications rather than mailed letters. Gan I elect to receivefollow up
communications about the verification process through email instead?
Yes. To go greenand receiveall futurecommunications pleasego to the "My Account"tab at
electronically,
www.VerifyOS.comand enteryour emailaddressin the "My Information" section. Once you validateyour email
addressas correct,you will be promptedto log back intothe site where you may then clickon the "Enable
Paperless"buttonto activateelectroniccommunications.

Q12. What if a dependent I am covering is not listed on the verification form?

Dependentsenrolledin coverageafter May 31,2018 are not includedin this dependentverificationprogram.
The Universityof lowa will verifythesedependentsat a laterdate.