Frequently Asked Questions About Coverage for Family Members
A. FEHB Program coverage is available for the employee's current spouse and unmarried dependent children under age 22, including legally adopted children and recognized natural children born out of wedlock. Stepchildren and foster children (including grandchildren, if they qualify as foster children) are included if they live with the employee in a regular parent-child relationship. Also, an unmarried dependent child age 22 or over who is incapable of self support because of a mental or physical incapacity which existed before age 22 may qualify for coverage under certain conditions. You cannot cover other relatives, such as your mother, even if they are otherwise considered your dependents.
An employee's agency makes enrollment eligibility decisions in accordance with the law and regulations. Ask your Human Resources Office for help in deciding whether your circumstances meet the requirements.
A. How you acquire a child (e.g., birth or adoption) does not matter. If you have self-only enrollment, you each need to complete an enrollment form to change to a self-and-family enrollment within 60 days of the event. The self-and-family enrollment will be effective the first day of the pay period in which the child was born or adopted. If you already have a self-and-family enrollment, you do not need to complete a new form; in this case, contact your plan to let them know about the new family member.
A. Your child can be covered under your self-and-family enrollment until he or she marries or turns age 22. It does not matter whether he or she attends college.
A. Your unmarried dependent child age 22 or over who is incapable of self-support because of a disability that existed before age 22 may be eligible for coverage under your FEHB enrollment. For more information, please see the FEHB Handbook for Enrollees and Employing Offices at http://www.opm.gov/insure/handbook/fehb29.asp
A. If the State in which you reside recognizes common-law marriages, yes.
A. Your grandchild may be eligible for FEHB coverage if he or she meets the eligibility requirements for foster children. These requirements are:
For your grandchild to be covered under your FEHB enrollment, you must sign a certification stating that your grandchild 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 submit this certification to your employing office for their determination that your grandchild meets these requirements. Your employing office will then notify your FEHB plan that your grandchild should be added to your enrollment.
A. No. The law defines family members as a spouse and an unmarried dependent child under age 22. Public Law 104-199, Defense of Marriage Act, states, " the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife."
A. The "Federal Employees Health Benefits Children's Equity Act of 2000" requires mandatory self and family enrollment coverage for FEHB-eligible employees who do not comply with a court or administrative order to provide health insurance coverage for their child(ren). You should send a copy of the court order to your spouse's Human Resources Office. They will ensure that your ex-spouse is enrolled in a self and family FEHB plan that provides coverage for the children.
If he is not enrolled in a self and family plan, his Human Resources Office will enroll him in the self and family plan of his current FEHB plan. If his current plan is an HMO and the child(ren) don't live within the service area of this plan, they will enroll him in the Basic Option of the Blue Cross and Blue Shield Service Benefit Plan. Please be sure to include your home address in your notification so that the Human Resources Office can make this determination.
The Human Resources Office will send you a copy of the SF 2809, Health Benefits Election Form. They will also send a copy to the FEHB plan so the plan can update their records and send ID cards to you. The Human Resources Office will flag your ex-spouse's health insurance records to prevent him from making a change to the self only plan for as long as the court order requires him to provide health insurance coverage to your child(ren) or until age 22, whichever occurs first.
A. Yes. You should still send a copy of the court order to your Human Resources Office to review and make a determination if any action is required. They will file the copy in your OPF and flag it so that they know a court order relating to health benefits has been filed. If your children aren't listed as family members on the SF 2809, they will send a copy of the court order to your FEHB plan.