Click here to view the CHR Domestic Partner Health Insurance Stipend Website for FAQ and Program Guidelines 

DEFINITION

1) We (Employee and Domestic Partner) have been united in civil union in accordance with the state law of previous domicile, or

2) We meet the following:

• We are emotionally committed to one another, share joint responsibilities for our common welfare and are jointly responsible for each other’s financial obligations as demonstrated by the presentation of three of the required proofs below.
• We each are at least 18 years of age and are mentally competent to consent to a contract.
• Neither of us is legally married to anyone else and we are not related to each other.
• We have shared financial responsibilities for at least the past six months.
• Domestic Partner is not employed or is not eligible for health benefits though his or her employer.

REQUIRED DOCUMENTS FOR ENROLLMENT

1) The employee’s partner must, if employed, show proof that his or her employer does not provide health insurance coverage, or the partner is not eligible for coverage by the available plan.

2) Proof of the partner’s insurance coverage (i.e. invoice or bill from insurance company) and proof of payment.

3) State civil union certificate, or proof of three of the following:

• Domestic Partner card
• Joint ownership of real property
• Mutual designation as attorney in a durable power of attorney document
• Joint ownership of personal property or assets, such as automobiles or stock
• Mutual designation of health care surrogate
• Joint bank account
• Driver’s license or tax documents showing the same address
• Joint consumer or bank loan
• Joint credit cards
• Joint lease
• Designation of beneficiary for life insurance, retirement plan and/or last will and testament
• Legal documentation demonstrating joint adoption or legal guardianship of any dependents, whether children or adults

DECLARATION

I have read and understand the definition(s) for the domestic partner listed above. I hereby affirm and attest to domestic partner eligibility. If any domestic partner is determined to be ineligible or I fail to notify University of South Florida Central Human Resources of a loss of eligibility or any supporting documentation is not provided upon request, I understand that I may be liable to repay any stipends received. Verification of premiums will be required on a quarterly basis.

ACKNOWLEDGEMENTS

By signing this declaration, I acknowledge I have been informed that:

1. I must notify Central Human Resources within 15 days of the effective date of change by completing a Termination of Domestic Partnership Stipend Eligibility form and understand that I will no longer be eligible to receive the stipend:

• If my Domestic Partner becomes eligible for insurance coverage through his or her employer.
• If there is any change in the status as domestic partners as certified in this Declaration.

2. Any stipend received by me after the effective date of termination of my eligibility must be repaid to University South Florida, and the amount may be deducted from future pay.

3. If I am employed under a contract or grant, my stipend is conditioned upon the continuation of funding of the contract or grant, the terms of the contract or grant, and the rules of the funding agency. If my eligibility under the contract or grant should change, I will notify the University of South Florida Central Human Resources and complete a Termination of Domestic Partnership Stipend Eligibility form.

4. The information provided in this Declaration is for use by Central Human Resources for the sole purpose of determining and maintaining eligibility for the Domestic Partnership Health Insurance Stipend Program.

Proof of the domestic partner’s health insurance premium and premium payment is required by Human Resources on a quarterly basis by February 15th, May 15th, August 15th, and November 15th of each year to continue your participation in the program. 

DEFINITION

1) We (Employee and Domestic Partner) have been united in civil union in accordance with the state law of previous domicile, or

2) We meet the following:

• We are emotionally committed to one another, share joint responsibilities for our common welfare and are jointly responsible for each other’s financial obligations as demonstrated by the presentation of three of the required proofs below.
• We each are at least 18 years of age and are mentally competent to consent to a contract.
• Neither of us is legally married to anyone else and we are not related to each other.
• We have shared financial responsibilities for at least the past six months.
• Domestic Partner is not employed or is not eligible for health benefits though his or her employer.

REQUIRED DOCUMENTS FOR ENROLLMENT

1) The employee’s partner must, if employed, show proof that his or her employer does not provide health insurance coverage, or the partner is not eligible for coverage by the available plan.

2) Proof of the partner’s insurance coverage (i.e. invoice or bill from insurance company) and proof of payment.

3) State civil union certificate, or proof of three of the following:

• Domestic Partner card
• Joint ownership of real property
• Mutual designation as attorney in a durable power of attorney document
• Joint ownership of personal property or assets, such as automobiles or stock
• Mutual designation of health care surrogate
• Joint bank account
• Driver’s license or tax documents showing the same address
• Joint consumer or bank loan
• Joint credit cards
• Joint lease
• Designation of beneficiary for life insurance, retirement plan and/or last will and testament
• Legal documentation demonstrating joint adoption or legal guardianship of any dependents, whether children or adults

DECLARATION

I have read and understand the definition(s) for the domestic partner listed above. I hereby affirm and attest to domestic partner eligibility. If any domestic partner is determined to be ineligible or I fail to notify University of South Florida Central Human Resources of a loss of eligibility or any supporting documentation is not provided upon request, I understand that I may be liable to repay any stipends received. Verification of premiums will be required on a quarterly basis.

ACKNOWLEDGEMENTS

By signing this declaration, I acknowledge I have been informed that:

1. I must notify Central Human Resources within 15 days of the effective date of change by completing a Termination of Domestic Partnership Stipend Eligibility form and understand that I will no longer be eligible to receive the stipend:

• If my Domestic Partner becomes eligible for insurance coverage through his or her employer.
• If there is any change in the status as domestic partners as certified in this Declaration.

2. Any stipend received by me after the effective date of termination of my eligibility must be repaid to University South Florida, and the amount may be deducted from future pay.

3. If I am employed under a contract or grant, my stipend is conditioned upon the continuation of funding of the contract or grant, the terms of the contract or grant, and the rules of the funding agency. If my eligibility under the contract or grant should change, I will notify the University of South Florida Central Human Resources and complete a Termination of Domestic Partnership Stipend Eligibility form.

4. The information provided in this Declaration is for use by Central Human Resources for the sole purpose of determining and maintaining eligibility for the Domestic Partnership Health Insurance Stipend Program.

It is your responsibility to notify the CHR Benefits team should you no longer qualify for the stipend.  It is also your responsibility to notify us of any decrease in premiums.  Failure to do so will result in a deduction for the full amount of the overpayment.  If your documentation is not received, your participation will be terminated, and any overpayment will be collected by the University.

NOTE: The Domestic Partner Insurance Stipend benefit is what the IRS terms as “supplemental wages,” and all supplemental wage payments are taxed differently than regular paychecks for federal withholding tax. For Social Security and Medicare taxes, the regular paychecks and the domestic partner stipend payments are each taxed at a flat 7.65%. For federal withholding, the regular paycheck is taxed based on taxable wages, claimed amount on the W-4, and the tax bracket the employee is in. Per IRS rules, supplemental wage payments are currently taxed at a flat 22% for federal withholding.