ndent Name: Dependent Name: Dependent Name: *B.Enter 'B' when this dependent is covered under both you and your spouse's insurance plan (married) S. Enter 'S' if you are the parent awarded custody o this dependent and no other *ndividual is required to pay for this dependent's medical expenses. F. Enter '

ndent Name: Dependent Name: Dependent Name: • &Enter '8' when this dependent is covered under both you and your spouse's insurance plan (married) S. Enter 'S' if you are the parent awarded custody o this dependent and no other individual is required to pay for this dependent's medical expenses F. Enter 'F