U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Eligibility

• Eligibility for Life Insurance
• Employees Excluded from Coverage
• Eligible Family Members under Option C
• Foster Child
• Child Incapable of Self-Support
• Historical Information

ELIGIBILITY FOR LIFE INSURANCE

• Basic Insurance
• Optional Insurance

Basic Insurance

As a Federal employee, you automatically have Basic insurance, unless you waive it or you are in a position excluded from FEGLI by law or regulation.

Optional Insurance

Optional insurance is not automatic; you must elect it.

You may elect Optional insurance if:

• You have Basic insurance;
• You do not have a waiver of that type of Optional insurance still in effect (or a waiver of that number of Option B or Option C multiples still in effect); and
• Your periodic pay, after all other deductions, is enough to cover the full cost.

EMPLOYEES EXCLUDED FROM COVERAGE

• Exclusions by Law
• Exclusions by Regulation

Exclusions by Law

The law excludes you from FEGLI coverage if:

• You are an employee of a corporation supervised by the Farm Credit Administration, if private interests elect or appoint a member of the board of directors;
• You are not a citizen or national of the United States and your permanent duty station is outside the United States. Exception: You are eligible for FEGLI if you met the definition of employee on September 30, 1979, by service in an Executive agency (as defined in 5 U.S.C. 105), the United States Postal Service, or the Smithsonian Institution in the area which was then known as the Canal Zone;
• You are a teacher in a Department of Defense dependents school overseas, if employed by the Federal Government in a non-teaching position during the recess period between school years; or
• You were first employed by the Government of the District of Columbia on or after October 1, 1987. Exceptions: You are eligible for FEGLI if you are:
  • An employee of St. Elizabeth's Hospital, who accepts employment with the District of Columbia Government following Federal employment without a break in service, as provided in section 6 of Pub. L. 98-621;
  • The Corrections Trustee or an employee of the Trustee who accepts employment with the District of Columbia Government within three days after separating from the Federal Government;
  • The Pretrial Services, Parole, Adult Probation and Offender Supervision Trustee or an employee of the Trustee;
  • Effective October 1, 1997, a judicial or non-judicial employee of the District of Columbia Courts, as provided by Pub. L. 105-33; or
  • Effective April 1, 1999, an employee of the Public Defender Service of the District of Columbia, as provided by Pub. L. 105-274.

Exclusions by Regulation

The regulations exclude you from FEGLI coverage if:

• You are serving under an appointment limited to one year or less. Exceptions: You are eligible for FEGLI coverage if:
  • Your full-time or part-time temporary appointment has a regular tour of duty and follows a position in which you were insured, with a break in service of no more than three days (unless during that prior position you had already completed 12 months in nonpay status);
  • You are an acting postmaster;
  • You are a Presidential appointee appointed to fill an unexpired term; or
  • You are a temporary employee who receives a provisional appointment as defined in 5 CFR 316.403;
• You are employed for an uncertain or purely temporary period, employed for brief periods at intervals, or are expected to work less than six months in each year. Exception: You are eligible for FEGLI coverage if you are employed under an OPM-approved career-related work-study program under Schedule B lasting at least 1 year, and you are expected to be in pay status for at least one-third of the total period of time from the date of your first appointment to the completion of the work-study program;
• You are an intermittent employee (a non-full-time employee without a regularly scheduled tour of duty). Exception: You are eligible for FEGLI coverage if your appointment follows, with a break in service of no more than three days, a position in which you were insured and to which you are expected to return (unless during that prior position you had already completed 12 months in nonpay status);
• Your pay, on an annual basis, is $12 a year or less;
• You are a beneficiary or patient employee in a Government hospital or home;
• You are paid on a contract or fee basis. Exception: You are eligible for FEGLI coverage when you are a United States citizen, appointed by a contract between you and the Federal employing authority which requires your personal service, and paid on the basis of units of time; or
• You are paid on a piecework basis. Exception: You are eligible for FEGLI coverage when your work schedule provides for full-time or part-time service with a regularly scheduled tour of duty.

OPM makes the final determination about whether the above categories apply to a specific employee or group of employees.

If you have an interim appointment under 5 CFR 772.102, you are eligible for FEGLI coverage even if your position is excluded by regulation. You are not eligible if your position is excluded by law.

ELIGIBLE FAMILY MEMBERS UNDER OPTION C

• Family Members
• Spouse
• Children
• Recognized Natural Child
• Parent-Child Relationship

Family Members

The FEGLI law defines family members for Option C coverage as your spouse and your unmarried dependent children under age 22.

No other family members are eligible under your Option C coverage.

Spouse

Option C covers your spouse of the opposite sex from a legal religious or civil ceremony. It also covers your spouse from a valid common-law marriage.

NOTE: All states do not recognize common-law marriage. You need to check with your state - not your agency or OPM -- to determine the validity of a common- law marriage.

This does not include a former spouse, a spouse from a same-sex marriage or a domestic partner.

Your spouse loses eligibility (and coverage) on the date your divorce is final. There is no 31-day extension of coverage or right to convert.

Children

Children must be unmarried and under age 22 to be eligible under Option C,

Exception: A child age 22 or over is eligible only if the child is incapable of self-support because of a physical or mental disability that existed before the child reached age 22.

Your eligible dependent children include:

• A child born within or outside of a marriage;
• An adopted child;
• A recognized natural child (including children born out of wedlock); or
• A stepchild or foster child who lives with you in a regular parent-child relationship.

Children born within marriage and adopted children are eligible whether or not they live with you or are financially dependent upon you.

See "Recognized Natural Child" for eligibility requirements of recognized natural children.

Stepchildren and foster children must live with you in a regular parent-child relationship to be eligible under Option C.

A stillborn child is not an eligible family member under Option C.

A grandchild is not an eligible family member under Option C (unless the grandchild meets all the requirements of a foster child).

If your child's marriage ends and he/she is under the age of 22 or over the age of 22 and incapable of self-support, the child is again an eligible family member under Option C.

Recognized Natural Child

A recognized natural child is your child born outside of marriage, whom you have acknowledged as your child. A recognized natural child is an eligible family member if he/she lives with you or if you contribute to the support of the child.

An insured individual is considered to be the father of such a child under one or more of the following conditions:

• The individual acknowledged paternity in writing;
• A court ordered the individual to provide support;
• Before the individual died, a court pronounced him to be the father;
• The individual named himself as the father on a certified copy of the public record of birth or church record of baptism; or
• Public records, such as records of schools or social welfare agencies, show that - with his knowledge - the individual was named as the father of the child.

If paternity is not established by one of the above means, OFEGLI may consider other evidence, such as the child's eligibility as a recognized natural child under other State or Federal programs or proof that the father included the child as a dependent child on his income tax returns.

Parent-Child Relationship

A "regular parent-child relationship" means that you are:

• Exercising parental authority, responsibility, and control over the child;
• Caring for, supporting, disciplining, and guiding the child; and
• Making decisions about the child's education and medical care.

FOSTER CHILD

• Eligibility Requirements
• When Coverage Ends
• When a Child Is Not Considered a Foster Child
• How to Get a Foster Child Covered
• Sample Certification

Eligibility Requirements

Your foster child is eligible to be covered under Option C when:

• The child is unmarried and under age 22 (if the child is over age 22, he/she must be incapable of self-support because of a physical or mental disability that existed before the child reached age 22);
• The child lives with you;
• The parent-child relationship is with you, not the child's biological parent;
• You are the child's primary source of financial support; and
• You expect to raise the child to adulthood.

These requirements for coverage of foster children under FEGLI are the same as those for coverage of foster children under the Federal Employees Health Benefits (FEHB) Program or the Federal Employees Dental and Vision Insurance Program (FEDVIP). If you already have a certification on file for the FEHB or FEDVIP Program, you do not have to complete a new certification for Option C coverage, unless you are electing or increasing Option C because you acquire a foster child.

You do not need to be related to the child; nor do you need to legally adopt him/her. As long as the above requirements are met, the child is an eligible foster child, even if:

• The child's natural parents are alive;
• The child's natural parent(s) lives with you; or
• The child receives some financial support from other sources (for example, Social Security payments or support payments from a parent).

Common examples of a foster parent-child relationship are:

• You are living with, supporting, and raising a child whose parents have died.
• A child is living with you under a pre-adoption agreement.
• A child is in your legal custody.

When Coverage Ends

Your foster child's coverage continues until he/she:

• Marries;
• Reaches age 22;
• Becomes capable of self-support if age 22 or over;
• Is no longer living with you; or
• Is no longer financially dependent on you.

If your foster child moves out of your home to live with a biological parent, the child cannot again be covered as your foster child unless:

• The biological parent dies;
• The biological parent is imprisoned;
• The biological parent becomes unable to care for the child due to a disability; or
• You obtain a court order for custody that takes parental responsibility from the biological parent and gives it to you.

When a Child Is Not Considered a Foster Child

A child is not considered a foster child when:

• The child has been placed in your home by a welfare or social service agency under an agreement where the agency retains control of the child and/or pays for maintenance.
• The child is living with you temporarily, or you are raising the child temporarily.

Example 1

Joyce's nephew moves in with Joyce while he is attending a nearby college. The nephew does not qualify as a foster child, since the living arrangement is a temporary one for convenience.

Example 2

Keith's unmarried teenage daughter has a baby. Keith and his wife are raising the grandchild while their daughter finishes school. The grandchild does not qualify as a foster child, since Keith is raising the child only temporarily and there is no expectation that Keith will be raising the child to adulthood.

How to Get a Foster Child Covered

For your foster child to be covered under Option C, 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.

If you already have a certification on file for the FEHB Program or FEDVIP, you do not have to complete a new certification for Option C coverage, unless you are electing or increasing Option C because of acquiring a foster child.

Sample Certification

You may use the following pattern statement to establish your foster child's eligibility for coverage under Option C. Your employing office must file the original certification in your Official Personal Folder (or its equivalent).

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, the Federal Employees Dental and Vision Insurance Program and/or Option C of the Federal Employees' Group Life Insurance Program:

1. 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.);
2. The child must be living with me;
3. 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; and I am making the decisions about the child's education and medical care;
4. I must be the primary source of financial support for the child; and
5. I must expect to raise the child to 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:

1. The biological parent dies;
2. The biological parent is imprisoned;
3. The biological parent becomes incapable of caring for the child due to a disability; or
4. I obtain a court order taking parental responsibility away from the biological parent and giving it to me.

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 applicable) 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)

(End of notice)

CHILD INCAPABLE OF SELF-SUPPORT

• Coverage
• Requirements
• Documentation of Incapacity for Self-Support
• Medical Conditions That Would Cause Children to Be Incapable of Self-Support during Adulthood

Coverage

Your unmarried dependent child age 22 or over is eligible to be covered under Option C if he/she is incapable of self-support because of a physical or mental disability that existed before the child reached age 22.

Requirements

Your employing office makes the determination as to whether your over aged dependent is eligible for coverage. Your child age 22 or over may be considered incapable of self-support only if his/her physical or mental disability is expected to continue for at least one year and, because of the disability, he/she isn't capable of working at a self-supporting job. (Self-supporting is usually considered to be the equivalent of a GS-5, step 1, salary.)

A disability such as blindness or deafness is not qualifying in itself because it does not necessarily make someone incapable of self-support. The onset of a disease before age 22 that doesn't result in incapacity for self-support until age 22 or after does not qualify a child for continued eligibility for coverage under Option C.

The criteria for your employing office's determination are the same as those for the FEHB Program and FEDVIP. If you have already established eligibility for your child under the FEHB Program, you do not need to establish eligibility again under FEGLI.

Documentation of Incapacity for Self-Support

To continue your child's eligibility under Option C once he/she reaches age 22, you must submit to your employing office a doctor's certificate about your child's disability. The doctor must sign the certificate, and the certificate must show the doctor's office address.

The certificate must state the following:

• Your child's name;
• That your child is incapable of self-support because of a physical or mental disability;
• That the disability started before the child reached age 22;
• That the disability is expected to continue for more than one year;
• The type of disability;
• How long the disability has existed; and
• The disability's expected future course and duration.

Your employing office must document its determination in your Official Personnel Folder (or its equivalent). The determination may be permanent or it may be for a specific period of time, after which you will need to provide additional information to continue your child's eligibility. If you have already established eligibility for your child under the FEHB Program or FEDVIP, you do not need to establish eligibility again under FEGLI.

When you file a claim for the death of an overage dependent, your employing office must certify to OFEGLI that the child met the requirements for coverage. If you don't have an employing office determination on file, you may provide the required doctor's certificate after the child's death so that your employing office can make a determination and certification to OFEGLI.

Medical Conditions That Would Cause Children to Be Incapable of Self-Support during Adulthood

Documentation of one of the following conditions automatically makes your child age 22 or over eligible for coverage under Option C. If your child's condition is not listed, your employing office will make its determination based on the documentation you submit:

• AIDS - CDC classes A3, B3, C1, C2, and C3 (not seropositivity alone)
• Advanced muscular dystrophy
• Any malignancy with metastases or which is untreatable
• Chronic hepatic failure
• Chronic neurological disease, whatever the reason, with severe mental retardation or neurologic impairment, for example:
  • Cerebral palsy
  • Ectodermal dysplasia
  • Encephalopathies
  • Uncontrollable seizure disorder
• Chronic renal failure
• Inborn errors of metabolism with complications, such as the following:
  • Adrenoleukodystrophy
  • Gaucher disease
  • Glycogen storage diseases
  • Homocysteinuria
  • Lesch-Nyhan disease
  • Mucopolysacharide disease
  • Nieman-Pick Disease
  • Phenylketonuria
  • Primary hyperoxaluria
  • Tay-Sachs disease
• Mental retardation with IQ of 70 or less
• Severe acquired or congenital heart disease with decompensation which is not correctable
• Severe autism
• Severe juvenile rheumatoid arthritis
\
• Severe mental illness requiring prolonged or repeated hospitalization
• Severe organic mental disorder
• Xeroderma pigmentosa

HISTORICAL INFORMATION

• Active Duty Military
• Part-Time Employees
• D.C. Government Control Board
• Foster Children

Active Duty Military

From August 1, 1956 until June 6, 1986 by law FEGLI coverage terminated whenever a Federal employee was called up to active military duty. As of June 6, 1986, employees called up to active duty could keep their FEGLI coverage for up to 12 months, just as any other employee in nonpay status. Public Law 110-181, the Department of Homeland Security Appropriations Act, enacted January 28, 2008, changed this provision by authorizing the continuation of life insurance coverage for up to 24 months instead of 12 months while in nonpay status.

Part-Time Employees

Part-time employees were originally excluded. They became eligible some time between 1961 and 1964.

D.C. Government Control Board

Employees of the D.C. Control Board (District of Columbia Financial Responsibility and Management Assistance Authority), who made an election under the Technical Corrections to Financial Responsibility and Management Assistance Act (section 153 of Pub. L. 104-134) to be considered Federal employees for life insurance and other benefits purposes were eligible for FEGLI coverage. (Employees of the D.C. Control Board who were former Federal employees were subject to the provisions of this Handbook concerning canceling waivers.)

Foster Children

Foster children became eligible for Option C coverage effective October 30, 1998. Before that, foster children were not eligible.