2024 Health Plan Dependent Audit & Required Certification
The Benefits Division in the Department of Human Resources is conducting an official review and verification of dependents who are covered on county-sponsored health plans.
The purpose for this review and verification is to ensure the eligibility of all dependents who are covered under a Fairfax County Government sponsored health plan.
Additional information, including a step-by-step guide on how to review your benefit enrollments and dependents along with an FAQ, can be found in the Resources section below.
Take Action Now!
All employees covering a dependent in a county-sponsored health plan, medical, vision, and/or dental plan, must complete the 2024 Health Plan Dependent Certification Form and submit it to the Benefits Division in the Department of Human Resources before Friday, December 1, 2023.
The form does not enroll dependents, but certifies that a spouse or other dependent(s) currently covered under a county-sponsored health plan is legally eligible to be covered.
What information do you need to provide?
The completed form must include each eligible, covered dependent (spouse, child, stepchild, etc.) and their personal information. This includes each dependent’s name (as listed on their Social Security Card), their date of birth, gender (or gender identification), and Social Security Number or Nine-digit Tax ID.
Remember that the vision care plan is bundled with the medical plan and you do not include dependents for any other benefit plans such as Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Dependent Life Insurance, or beneficiaries on the 2024 Health Plan Dependent Certification Form.
Additional supporting documentation does not need to be submitted with the form. If anything, additional is needed, a Benefits team member will contact employees directly via their county email.
If you need to review current enrollment and dependent information, a step-by-step guide can be found in the Resources section below.
Benefits team members will not confirm enrollments or covered dependents and will not provide the required details about your dependents for the form.
Where do submit the form?
The completed, signed form is to be returned directly to the Benefits Division in the Department of Human Resources. The Benefits Division can accept your completed form as follows:
In-Person, By Mail, or by Interoffice Mail*
Department of Human Resources, Benefits Division
12000 Government Center Parkway, Suite 270, Fairfax, VA 22035
*A secure drop-box will be available outside of the Department of Human Resources
By Email*: HRCentral@fairfaxcounty.gov
*Include "Attention: Benefits Division - "Dependent Audit" in the subject line
By Secure Fax: (703) 802-8795
County-sponsored health plan coverage for any spouse and/or dependents who remain uncertified by the employee will be terminated effective December 31, 2023.
