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EDB MANUAL, SECTION E - BENEFITS

E6.0 EDB BENEFITS - DEPENDENT DATA


The Dependent Data (EDEP) screen is used for adding, changing, or canceling coverage in UC-sponsored health and welfare benefits for employees' eligible dependents.

PPEDEP0-E1281                 EDB Entry/Update                07/02/YY 12:01:44
07/01/YY 23:42:39              Dependent Data                 Userid:  ABCDE   
ID: 121212121 Name: EXAMPLE,IMA                                  Pri Pay: MO    
                                                                  Pg 1  of 1    
                                                                                
     Dependent Name                 Deenrol Birth  Coverage Effective/End Dates 
 No  Relationship         Sex SSN     CTL   Date   Medical Dental Vision Legal  
 51  EXAMPLE,ASA N                         081260  0701YY  0701YY 0701YY        
     S SPOUSE              M 212121212                                          
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 Next Func:      ID:           Name:                            SSN:            
                                                                                
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 F:  1-Help      2-Jump      3-PrevMenu                                        
 F:                          9-Update                           12-Exit

 

For DEPENDENT eligibility and enrollment criteria, please refer to Chart 4.C.
For PIE criteria, please refer to Chart 4.B.

 

E6.1 Dependent Number

This is a two-digit identification number assigned to each eligible family member. The spouse is usually assigned the first dependent number of 51 and other eligible dependents (i.e.,children) should begin at 52.

E6.2 Dependent Name

This is a 26-character field that indicates the name of the eligible family member. Enter the name as Last, First Middle.

NOTE: DO NOT put a space between comma and first name ( i.e., Smith,John A).

E6.3 Birth Date

This is a six-digit number that indicates the eligible family member’s date of birth. Enter as MMDDYY.

E6.4 Relationship

This is a one-character code that identifies the familial relationship of the eligible family member to the employee.

S Spouse
C Child (natural or adopted)
O Other Child (e.g., foster child)  Do NOT use this code for current enrollments. Reserved for enrollments 9/1/1994 or prior.
P Stepchild
G Grandchild
W Legal Ward
D Domestic Partner
L Opposite Sex Domestic Partner
K Child/Grandchild of Domestic Partner
A Adult Dependent Relative (Not available as of 1/1/2004)
N Non Tax-Dependent Overage Disabled Child

E6.5 Coverage Effective Date for Medical, Dental, Vision and Legal

This is a six-digit number that indicates the effective date for the insurance coverage for the eligible family member. Enter as MMDDYY.

E6.6 Social Security Number (SSN)

This is the nine-digit Social Security Number of the family member.

E6.7 Dependent Gender

This is a one-character code that indicates the gender of the eligible family member:

M Male
F Female


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