[Montgomery County, MD] 2025 Active Health and Life Insurance Open Enrollment Form

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Please upload the necessary required documentation (i.e. marriage and birth certificates). Click HERE for more information on required documentation.

If you have more than one child and need to provide multiple birth certificates, it is recommended that you combine all of the birth certificates into one document before attaching.

There is a 250MB limit on each attachment.

Official state marriage certificate (certified by appropriate state or county official) Click Here to Upload

State birth certificate Click Here to Upload

Adoption or placement for adoption papers Click Here to Upload

Medical plan verification of disability prior to age 26 (For disabled dependent over 26) Click Here to Upload

Court order granting legal custody (legal guardianship) Click Here to Upload

Proof of new/cancelled coverage documentation (Gaining/losing coverage elsewhere) Click Here to Upload

Death certificate Click Here to Upload

Divorce Decree Click Here to Upload

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