As I previously pointed out, the law allows children to be covered by Federal Employees Health Benefits program up to age 26, even if they are married. At that point, their FEHB coverage usually ends. However, that age limit doesn’t apply to a child who is incapable of self-support and unmarried.
If you are an employee or retiree who is enrolled in a self plus one or self and family option of an FEHB plan, your child can continue to receive health benefits coverage beyond age 26 if you provide evidence to support such a claim.
Acceptable evidence includes:
• 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, or
• a medical certificate documenting that the child is incapable of self-support
If you are an employee, you’ll have to provide that evidence to your personnel office, which is responsible for determining if the criteria are met. If they are, it will notify your FEHB plan. If you are retired, you’ll have to notify OPM, which will make the determination and provide it to your plan.
Depending on the nature of your child’s disability, it may be necessary to periodically provide evidence that the disabling condition still exists.
The health benefits coverage of your disabled child will end if the child marries, recovers from the disability, becomes capable of self-support, or dies. However, the benefits usually can be restored if the marriage ends, the original disability returns or your child becomes 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, OPM will consider both the child’s earnings and his or her current condition or prognosis.