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 children under age 26, including legally adopted children, recognized natural (born out of wedlock) children and stepchildren.
Foster children are included if they meet the requirements listed here:
- the child must be under age 26 (if the child is age 26 or over, he/she must be incapable of self-support);
- the child must currently live with you;
- the parent-child relationship must be with you, not the child's biological parent;
- you must currently be the primary source of financial support for the child; and
- you must expect to raise the child to adulthood.
A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 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 a child under age 26. 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.
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 under age 26 (if the child is over age 26 or over, he/she must
be incapable of self-support);
- the child must currently live with you;
- the parent-child relationship must be
with you, not the child's biological parent;
- you must currently 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
Certification for Foster Children
You may use the following link to the foster child certification 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:
- The child must be under age 26. (If the child is age 26 or older, he/she can only be covered if he/she is
incapable of self-support because of a disabling condition that began before age 26. I must provide
documentation of this to my employing office.);
- The child must currently live with me;
- I must currently be the primary source of financial support for the child;
- The parent-child relationship must be with me, not with the biological parent. This means that I am exercise
parental authority, responsibility, and control. I care for, support, discipline, and guide the child. I
make the decisions about the child's education and health care; and
- 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 am the primary source of
financial support for this child; I have a regular parent-child relationship with this child, as described
above; and I intend to raise this 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 this child 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)