Last week I wrote about the benefits implications for federal employees and retirees who get married. This time I want to focus on the considerations arising on the birth or adoption of a child.
First we have to find out who qualifies as a child under the Federal Employees Health Benefits program. According to OPM, the following qualify: “children under age 26, including adopted children, recognized natural (born out of wedlock) children and stepchildren (including children of same-sex domestic partners).” Depending on your family situation, you can change enrollment, for example from self plus one to self and family.
With one exception, there isn’t any requirement that your child be a student or live with you to be covered under the FEHB program or be financially dependent on you. Here’s the exception. To be eligible, a foster child must be under age 26; currently live with you; have you as the primary source of financial support; and enjoy a parent-child relationship with you, not with his or her biological parent(s). In addition, you must expect to raise the child to adulthood. Finally, you must sign a certified statement that your foster child meets all these requirements.
Although FEHB coverage for children ends at age 26, there is an exception. If you have a child who is incapable of self support because of a mental or physical disability that existed before age 26, that FEHB coverage can continue without interruption.
If your child ages out of coverage, it’s up to you to let your agency know that child is no longer eligible for coverage. (OPM if you are an annuitant). If you have no other family members eligible for coverage, you can switch to self only. If you have one other eligible family member, you can switch to self plus one. And if you were enrolled in the self and family option and have at least three remaining family members to cover (including yourself), you can continue your enrollment in the self and family option.
Note: If you have a child whose FEHB coverage ends at age 26, he or she will get a no-cost 31-day temporary extension of coverage and be eligible to continue that coverage under the temporary continuation of coverage provision for up to 18 months. Anyone electing TCC is required to pay 100 percent of the premiums, plus 2 percent for administrative expenses.