Expert's View

Reg Jones

I’m going to start this series on health and life insurance by focusing on health insurance and what it means for those of you who have children.

Because many of those children will either be leaving to go away to college or have already left home for that or other reasons, it’s important for you to understand how this will affect their coverage under the Federal Employees Health Benefits program. Then I’ll discuss what will happen to their health and life insurance coverage if you were to die.

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Health benefits coverage while you are alive
If you are enrolled in the FEHB program and provided coverage for your child under the Self Plus One option or children under the Self and Family option, they can continue that coverage to age 26, That’s true even if your child or children are married and not living at home.

While fee-for service plans, such as Blue Cross/Blue Shield and GEHA, can accept and pay bills for covered services wherever your child may be, things are not as simple if you are enrolled in a Health Maintenance Organization (HMO). Most of them require that the services be provided either at their location or by someone in their provider network, which can be large or small depending on the HMO’s area of coverage. Therefore, it’s important for you to find out if your child will be living in an area which is serviced by your plan. If he or she isn’t, you’ll have to check with your plan to find out if it will honor any bills that are run up while the child is either away from home or living separately. If they aren’t, you may want to consider switching to another plan during the upcoming FEHB Open Season.

Health benefits coverage if you die
If you die while enrolled in the FEHB program and have Self and Family coverage, any survivors who meet the definition of “family member” will automatically be able to continue that coverage, as long as any one of them receives a survivor annuity. The same is true if you are covered by the Self Plus One option, and the “one” is a child who is age 26 or younger. As pointed out above, a child’s coverage continues to that age even if he or she is married and not living at home.

If there is no surviving parent, there wouldn’t be any annuity payments from which your child’s FEHB premiums could be deducted. If that were the case, your child could either 1) convert to an individual policy, which has no time limit or 2) apply for temporary continuation of coverage (TCC), which would provide coverage for up to 36 months. In either case, the child would have to pay the full cost and, if enrolled in TCC, an additional 2 percent for administrative expenses.

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