Your child's coverage will continue at no cost for 31 days starting from the date he or she turns 26 years old, with one exception. Image: sasirin pamai/Shutterstock.com
By: Reg JonesIt’s a given that children who are covered under a parent’s FEHB self and family or self plus one options can continue to be covered by it until age 26. That’s true whether they are living at home or away from home. How it works out in practice depends. I’ll get to that in a moment. First, I want to establish who qualifies as a child.
By law the term “child” includes your biological child, stepchild and legally adopted child. To establish that, you can provide a government issued birth certificate (or certificate of live birth), the front page of your most recent tax year’s federal or state tax return, official paternity test or another credible document. If you have a foster child, he or she is only eligible for coverage if the child meets certain requirements. For example, currently living with you, you are the primary source of financial support, and you expect to raise the child to adulthood.
Now that the definition of child is out of the way, let’s turn to the key question. Will your child have health insurance coverage under your plan when away from home, for example going away to college?
If covered under a nationwide plan, such as Blue Cross & Blue Shield, GEHA or NALC, your child can receive care anywhere in the United States and its territories and have those bills treated as if he or she was still at home with you. (Note: If your child is living outside the U.S.—for example, doing a study abroad semester—he or she may have to pay for the services received out of pocket and later be reimbursed by the plan. Check your plan’s benefits brochure – or give them a call – to see how they handle it.)
On the other hand, if your child is covered under your health maintenance organization (HMO) enrollment, whether he or she will receive covered care depends on that plan’s area of operation. While some HMOs are nationwide, they may only have a presence is cities with a large population. Others may be limited to one specific area. You’ll have to check your plan’s benefits brochure – or give them a call – to find out if your child will be covered when living outside that area of coverage.
Here’s another consideration for coverage of young adult children: When your child reaches age 26, he or she will no longer be an eligible family member on your FEHB plan. What happens then?
Your child’s coverage will continue at no cost for 31 days starting from the date he or she turns 26 years old. Then, with one exception, your plan will remove your child as a family member. Here’s the exception. If you have a child who is incapable of self-support, he or she may be eligible to stay on your FEHB plan beyond age 26.
Under the Temporary Continuation of Coverage (TCC) provision, your eligible child will be able to enroll in an FEHB plan when his or her eligibility as a family member on your plan ends. Your child can then choose from among the same plans that are available to all employees and is not limited to the plan you are enrolled in. Under TCC, your child would pay the full premium; in other words, both the enrollee and government shares plus a 2 percent administrative fee.
You must inform your agency personnel office within 60 days of your child turning 26 years old that he or she wants to be covered by TCC and provide your child’s mailing address. Then, your personnel office will send your child a notice about how to enroll in it. Your child must request enrollment within 60 days from the later of his or her 26th birthday, or the date of the TCC notice from your agency. Your child may continue TCC for up to 36 months from the date he or she turns 26 years old. When TCC expires, your child will have the option of converting to an individual contract.
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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