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Your employing office is responsible for making decisions about whether a family member is eligible for coverage. If the carrier of your health benefits plan has any questions about whether someone is an eligible family member, it may ask you or your employing office for more information. The carrier must accept your employing office's decision on your family member's eligibility.
Family members eligible for coverage under your self and family enrollment are your spouse (including a valid common law marriage) and unmarried dependent children under age 22, including legally adopted children and recognized natural (born out of wedlock) children who meet certain dependency requirements. Your stepchildren and foster children are included if they live with you in a regular parent-child relationship. An unmarried dependent child age 22 or over who is incapable of self-support because of a mental or physical disability that existed before age 22 is also an eligible family member. In determining whether the child is a covered family member, your employing office will look at the child's relationship to you as the enrollee.
A grandchild is not an eligible family member, unless the child qualifies as your foster child.
When you enroll for self and family, you automatically include all eligible members of your family. If you don't list an eligible family member on your Health Benefits Election Form (SF 2809) or other enrollment request, that person is still entitled to coverage. If you list a person who is not an eligible family member, your employing office will explain why the person is not eligible for coverage and will remove the name from the list. The listing of an ineligible person on the SF 2809 doesn't entitle him/her to benefits.
Your child must be financially dependent upon you to qualify as an eligible family member. Your child is automatically considered to be financially dependent upon you if the child is:
If you submit proof to your employing office that you don't live with or contribute to the support of your child, then the child is not considered an eligible family member. If the child is an eligible employee, he/she may enroll in the Program in his/her own right.
If you want to provide coverage for a recognized natural child who doesn't live with you in a regular parent-child relationship and isn't protected by a court determination of support, you must establish dependency by submitting proof of your regular and substantial support of the recognized natural child to your employing office. Your employing office will determine whether financial dependency has been established.
The following are some examples of proof of dependency (more than one of these may be required):
If your married child under age 22 or over age 22 and incapable of self-support becomes divorced or widowed, he/she may again be covered under your self and family enrollment as an eligible family member.
If your child's marriage is annulled and he/she is under age 22, his/her family member status is restored. In the case of a voidable marriage (one that was legal when performed but was annulled; e.g., for fraud or lack of consummation), coverage is made retroactive to the effective date of the annulment decree. If the marriage was void initially (ab initio - it was illegal from the beginning ; e.g., one of the partners was already married), coverage is made retroactive to the date of the marriage so that there is no break in family member status.
Applicable State law governs whether a child has been adopted. The child is adopted if the adoption decree is final. The child also is considered adopted if the adoption decree is interlocutory and State law provides that the rights of the child generally are the same as those of an adopted child.
In general, your spouse's legitimate or adopted child, or child born out of wedlock is considered to be your stepchild. However, your spouse's stepchild (by a previous marriage) is not your stepchild.
Under the FEHB Program, your stepchild remains a stepchild and an eligible family member after your divorce from, or the death of, the natural parent, provided that the stepchild continues to live with you in a regular parent-child relationship.
If your stepchild stops living with you in a regular parent-child relationship, the child is eligible for coverage under temporary continuation of coverage (TCC) provisions because he/she no longer meets the definition of an eligible child.
If you divorce and your former spouse is eligible to enroll under either the spouse equity or TCC provisions, only the natural or adopted children of both you and your former spouse are covered under your former spouse's self and family enrollment. Your stepchildren are not covered even though they may have been covered previously by your self and family enrollment. However, they may qualify for a TCC enrollment of their own.
To be considered a foster child for health benefits purposes:
You don't need to be related to the child nor do you need to legally adopt him/her. As long as the above requirements are met, you may have a foster parent-child relationship even when:
Common examples of a foster parent-child relationship are:
For your foster child to be covered under your FEHB enrollment, you must sign a certification stating that your foster child meets all the requirements and that you will notify your employing office if the child marries, moves out of the home, or stops being financially dependent on you.
You may use the following pattern statement to establish your foster child's eligibility for coverage as a family member to your employing office. Your employing office must file the original statement in your Official Personal Folder.
CERTIFICATION FOR FOSTER CHILDREN
I have been informed of the following requirements for coverage of a foster child under the Federal Employees Health Benefits Program and/or Option C of the Federal Employees' Group Life Insurance Program:
I understand that if the child moves out of my home to live with a biological parent, he/she loses coverage and cannot ever again be covered as a foster child unless the biological parent dies, is imprisoned, or becomes incapable of caring for the child due to a disability, or unless I obtain a court order taking parental responsibility away from the biological parent.
This is to certify that: (name of child) lives with me; I have a regular parent-child relationship with (name of child), as described above; I am the primary source of financial support for (name of child); and I intend to raise (name of child) into adulthood.
I will immediately notify both my employing office and the health benefits carrier if the child marries, moves out of my home, or ceases to be financially dependent on me.
(Print name of employee/annuitant) (Social Security Number)
(Signature of employee/annuitant) (Date)