Family Members
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Family Members Eligible for Coverage
Employing Office Responsibilities
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.
General
Eligibility for Coverage
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.
Special rules apply to family members if you are enrolled as a survivor annuitant or under
the Spouse Equity or temporary continuation of
coverage (TCC) provisions.
Defense of Marriage Act
Same sex partners are not eligible family members. 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."
Eligible
Family Members Automatically Covered
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.
Dependency Requirement
Your child is automatically considered to be financially dependent upon you if the child is:
- your legitimate child;
- your adopted child;
- your stepchild, foster child, or recognized natural child who lives with you in a
regular parent-child relationship; or
- your recognized natural child for whom a judicial determination of support has been
obtained or to whose support you make regular and substantial contributions.
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.
Proof
of Recognized Natural Child's Dependency
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):
- evidence of eligibility as a dependent child under other State or Federal programs;
- proof that you included the child as a dependent on previous tax returns;
- canceled checks, money orders, or receipts for periodic payments made by you for or on
behalf of the child;
- evidence of goods or services that show you made regular or substantial contributions;
or
- any other significant proof of support or of paternity.
When Your
Child's Marriage Ends
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.
Adopted Children
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.
Stepchildren
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.
Foster Children
Requirements
To be considered a foster child for health benefits purposes:
- the child must be unmarried and under age 22 (if the child is over age 22, he/she must
be incapable of self-support);
- the child must live with you;
- the parent-child relationship must be
with you, not solely the child's biological parent;
- you must be the primary source of financial support for the
child; and
- you must expect to raise the child to adulthood.
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:
- the child's natural parents are alive;
- the child's natural parent lives with you; or
- the child receives some support from sources other than you (for example, social
security payments or support payments from a parent).
Common examples of a foster parent-child relationship are:
- A child whose parents have died is living with, and being supported by, a close relative
who is an enrollee.
- A child who is living with and financially dependent on a grandparent who is an
enrollee. (The natural parent of the child may also be a dependent.)
- A child living with an enrollee under a preadoption agreement.
- A child who is in the legal custody of an enrollee.
How to Get a
Foster Child Covered
For your foster child to be covered under your FEHB enrollment, you must provide documentation of your regular and substantial support of the child; 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.
Sample Statement
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:
- The child must be unmarried and under age 22. (If the child is over age 22,
he/she can only be covered if he/she is incapable of self-support because of a disabling
condition that began before age 22. I must provide documentation of this to my employing
office.)
- The child must be living with me.
- The parent-child relationship must be with me, not with the biological parent.
This means that I am exercising parental authority, responsibility, and control; I am
caring for, supporting, disciplining, and guiding the child; I am making the decisions
about the child's education and health care.
- I must be the primary source of financial support for the child.
- I must expect to raise the child into adulthood.
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 have provided my employing agency proof of my regular and substantial support for (name of child).
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)