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: ===> F: 1-Help 2-Jump 3-PrevMenu F: 9-Update 12-Exit
eligibility and enrollment criteria,
please refer to
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 members date of birth. Enter as MMDDYY.
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