In the first of this series on the impact of life events on your federal benefits, we started last week with options that become available to you if you get married. In this article we’ll turn to one of the most important life event considerations, health benefits when a child enters your life.
According to the Office of Personnel Management, children eligible for FEHB are:
• a child under age 26 (or any age if they are incapable of self-support because of a mental or physical disability that began before age 26);
• a legally adopted child;
• a recognized child born out of wedlock;
• a stepchild; and
• a foster child.
As a rule there’s no requirement that a child meeting one of those definitions be a student, live with you, or be financially dependent on you. The exception is that 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 and must sign a certified statement that your foster child meets all these requirements.
On adding a child that meets any of those definitions, you may newly enroll or increase an existing enrollment from 31 days before to 60 days afterward; otherwise you would have to wait until the next benefits open season, annually from early November through early December.
If you are enrolled in self only, you may change to self plus one or to self and family. If you have a self plus one enrollment, you may increase to self and family. These changes, as well as a new enrollment, require filing a new health insurance enrollment form as described last week.
If you have a self and family enrollment, you do not need to complete a new health insurance enrollment form; however, you must contact your health plan directly to inform it of the new family member.
Note: In all cases, you may be required to provide certain documentation of eligibility.
Length of coverage
Your enrollment in the FEHB program—and therefore the enrollment of children so long as they remain eligible—will be continuous throughout your career and will extend into retirement as long as you have been enrolled in the program for the 5 consecutive years before you retire. Coverage under Tricare can be used to meet the 5 year requirement, as long as you are enrolled in the FEHB program when you retire.
Your enrollment ends if you either cancel that coverage or resign from the government. If you resign, you’ll be entitled to 31 days of free FEHB coverage, after which you can extend that coverage for up to 18 months under the Temporary Continuation of Coverage (TCC) provision. If you do, you’ll have to pay the full cost of the premiums, plus 2 percent to cover administrative expenses.
When a child’s coverage ends
While a child’s coverage under the FEHB program ends at age 26, children can personally enroll for 36 months and pay the full premiums for their own coverage. Note: As mentioned above, if you have a child who is unmarried and incapable of self support because of a mental or physical disability that existed before age 26, that coverage can continue without interruption.
If you have no other family members eligible for coverage under your own plan, 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 that enrollment.
You have from 31 days before your child turns 26 to 60 days after that to make any change in your own coverage. If you are an employee, it’s up to you to let your agency know when a family member is no longer eligible for coverage under your enrollment. If you are a retiree, notify OPM.