In making a decision, consideration will be given to the both child’s earnings and his or her condition or prognosis. Image: Valery Evlakhov/Shutterstock.com
By: Reg JonesOver the last three weeks ago I’ve written about the annuity benefits available to surviving children of deceased federal employees and retirees. As I pointed out, the law allows them to be covered under Federal Employee Health Benefits up to age 26, even if they are married. Then the coverage usually ends.
However, that isn’t the case for the health benefits of a child who is unmarried and incapable of self-support. If you are enrolled in one of the FEHB plans, your disabled child will continue to receive health benefits coverage on providing 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.
In the case of employees, that information must be provided to the employing agency personnel office, which will determine if the criteria are met. If they are, it will let your FEHB plan know of its determination.
In the case of retirees, it must be provided to the OPM, which will make the determination and provide it to the FEHB 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 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 the child is no longer capable of self-support.
Note: The term “incapable of self-support” generally means that the child is capable of earning only a salary that is less than the equivalent of GS-5, step 1. However, be aware that this is not a hard and fast rule. In making a decision, consideration will be given to the both child’s earnings and his or her condition or prognosis.
Former head of retirement and insurance policy at the Office of Personnel Management, and longtime FEDweek contributor, Reg Jones is known throughout the federal workforce community as an authority on pay and benefits.
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