FEDweek

Children’s Benefits—Health Benefits for Disabled Children

Last week I wrote about life and health benefits available to your children. As I pointed out, the new law allows children to be covered up to age 26, even if they are married. At that point, the coverage ends. That isn’t the case for a child who is unmarried, incapable of self-support, and disabled before age 26.

If you are enrolled in one of the Federal Employee Health Benefits (FEHB) plans, your disabled child will continue to receive health benefits coverage if you provide the necessary evidence to support such a claim, for example:

* certification by a state or federal rehabilitation agency that the child is unemployable,

* receipt of survivor benefits from CSRS or FERS as a disabled child,

* receipt of benefits from Social Security or OWCP as a disabled child,

* a medical certificate documenting that the child is incapable of self-support, or

* other acceptable documentation.

If you are an employee, you’ll have to provide that information to your personnel office, which will determine if the criteria are met. If they are, it will let your FEHB plan know of its determination. If you are retired, you need to notify OPM, which will make the determination and provide it to your plan. Depending on the nature of the disability, it may be necessary to periodically reconfirm that the disabling condition still exists.

The survivor benefits and health benefits coverage of a disabled child will end if the child marries, recovers from the disability, becomes capable of self-support, or dies. The benefits usually can be restored if a marriage ends, the original disability returns or the child is no longer capable of self-support.

Note: The term "incapable of self support" generally means that the child earns less than the equivalent of GS-5, step 1. However, this is not a hard and fast rule. In making a decision, consideration is given to the child’s earnings and condition or prognosis.