Associates may cover, under the Medical, Dental and Vision plans, same gender or opposite gender partners with whom they reside and have a committed, long-term relationship of mutual support, and for whom they have assumed long-term financial responsibility or have mutual financial responsibility. Please see the Declaration Statement of Domestic Partnership for details.

Steps to enroll your domestic partner:

1. You and your partner must complete and sign the Declaration Statement of Domestic Partnership.
2. Upon request, you must be able to provide at least three of the following documents to establish proof of financial interdependence:
1. Domestic Partnership agreement
2. Joint mortgage, lease, or deed
3. Joint ownership of a vehicle
4. Joint checking account or credit account
5. Designation of domestic partner as primary beneficiary on life insurance or retirement contract
6. Durable property and health care powers of attorney
7. Other legal or financial documentation evidencing joint responsibility
3. Send the Declaration Statement of Domestic Partnership to: Corporate HR Benefits Dept., Payless ShoeSource, Inc., P.O. Box 1189 , Topeka , KS 66607.

Other Important Information

• It is recommended that you seek legal advice from your attorney regarding possible legal and financial implications before you take the actions required to provide benefit coverage to a Domestic Partner.
• Click here to see a list of plans in which coverage is available for Domestic Partners.
• The premium you pay for coverage for your Domestic Partner will be paid on an after-tax basis, according to federal law. (Premiums for your coverage as an Associate will continue to be deducted from your pay on a before-tax basis.) In addition, the value of the Payless contribution for coverage for your Domestic Partner is taxable income to you.
• Coverage for your Domestic Partner will end if you and/or your Domestic Partner no longer meet one or more of the requirements for coverage. If you wish to drop coverage for your Domestic Partner, contact the Corporate HR Benefits Dept.
• If you or your Domestic Partner loses coverage under the medical or dental plan (due to a change in your eligibility or their eligibility), your Domestic Partner will not be eligible for continuation of coverage (COBRA).