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Cal Poly Pomona

Eligible Family Members

Picture of people walking on sidewalk, under a Jacaranda Tree, behind the Classroom, Laboratory, Administration (CLA) Building 98.

If you are a benefits-eligible employee, you may also cover your eligible family members for medical, dental, and vision benefits. Eligible family members include:

  • Your legally married spouse or registered domestic partner (A copy of your marriage certificate or Declaration of Domestic Partnership and your spouse's or domestic partner's Social Security number are required. Be sure to review CalPERS information online about domestic partners  to see specific requirements for enrollment.) .

  • Your unmarried children under age 23 who have never been married (this includes your natural-born children, adopted children, and stepchildren).

  • Your disabled dependent children of any age who have never been married and who are incapable of self support because of a mental or physical condition that existed prior to age 23 and continuously since age 23 (subject to CalPERS approval). A Questionnaire for the CalPERS Disabled Dependent Benefit Form (HBD-98) and Medical Report for the CalPERS Disabled Dependent Benefit Form (HBD-34) must be approved by CalPERS prior to enrollment and must be updated upon request.

  • Other children living in your household may be eligible if they have never been married and any of the following applies:
    • You have been granted legal custody or joint legal custody of the child;
    • The child resides with you (generally in absence of the natural or adoptive parents) and is economically dependent upon you; or
    • The child is the natural, adopted, step, or economically dependent child of your registered domestic partner.

    An Affidavit of Eligibility of Economically-Dependent Children Form (HBD-35) must be filed prior to enrollment of your economically dependent children and must be updated upon request.

Who's Not Eligible

Following is some additional information on who's not eligible to be covered as your dependent/family member for medical, dental, and/or vision coverage:

  • Children age 23 and over*
  • Children who have been married
  • Children's spouses
  • Disabled children over age 23, who were never enrolled or were deleted from coverage
  • Stepchildren of former spouses**
  • Parents
  • Grandparents
  • Cousins
  • Other relatives

*Unless approved by CalPERS for coverage as a disabled child over age 23.

**Stepchildren of former spouses are eligible when the employee retains custody. You must certify them as "economically dependent." The dissolution of marriage dissolves relationship as "step-parent and step-child."