Contact Kayla Lombardi at 874-9054 to enroll in health coverage for Civil Union, Domestic Partner or Common Law status.
Pamela is a notary and can assist you in notarizing the forms.

Civil Union Spouse Benefits and Domestic Partner Benefits

Civil Union: The State of Rhode Island Employee Health Plan extends health benefits to civil union spouses and their children. To qualify for coverage, employees must provide a copy of their civil union certificate, complete the Certification of Tax Dependent Status for a Civil Union Spouse Form and attach both to the Health Insurance Enrollment Form and submit to the Agency Personnel Office. You must notify the Office of Employee Benefits if the dependency status of your spouse changes.

Domestic Partner: The State of Rhode Island extends health benefits to same-sex and opposite-sex domestic partners of eligible employees. To qualify for coverage, employees must meet the requirements and provide the verification information listed on the Domestic Partner Affidavit. The Domestic Partner Affidavit and the Domestic Partner Dependent Declaration Form must be completed, signed, notarized, and returned to the Agency Personnel Office as well as the Health Insurance Enrollment Form. You must notify the Office of Employee Benefits if the dependency status of your domestic partner changes.

Imputed Income for Civil Union Spouse/Domestic Partners
Under federal law, the fair market value of the state’s contribution for health insurance coverage for a civil union spouse/domestic partner is considered imputed income to the employee, and must be reported as taxable income on the employee’s bi-weekly paycheck unless he/she qualifies as a dependent of the employee under the IRS regulations for health plans. It is the employee’s responsibility to consult with the appropriate tax advisors to determine whether or not a civil union spouse/domestic partner qualifies as a dependent under the IRS regulations, and to determine the resulting tax implications.  Employees are required to submit the Dependent Declaration form (see above). An example of imputed income calculations is available here.

Imputed Income for Civil Unions / Domestic Partner

Under federal law, the fair market value of the state’s contribution for health insurance coverage for a civil union spouse/domestic partner is considered imputed income to the employee, and must be reported as taxable income on the employee’s bi-weekly paycheck unless the domestic partner qualifies as a dependent of the employee under the IRS regulations for health plans. It is the employee’s responsibility to consult with the appropriate tax advisors to determine whether or not a civil union spouse/domestic partner qualifies as a dependent under the IRS regulations, and to determine all tax implications resulting from the decision to add a domestic partner.

Common Law

You must be filing Federal Taxes together.  Please attach your most recent signed Federal Tax Form as substantiation of your marital status.

• Complete the Common Law Affidavit and provide the necessary evidence used to verify common law status.
• complete the Health Insurance Enrollment Form.