Last week I wrote about the choices available to you under the federal health insurance programs if you get married. This time I want to focus on insurance considerations involving addition of children, another “life event” under those programs that triggers such choices.
In the Federal Employees Health Benefits program, the term “child” includes children under age 26, including adopted children, recognized natural children born out of wedlock, stepchildren (including children of same-sex domestic partners), and foster children. However, this being the government, there’s a caveat. If you have a child, he or she is only eligible for coverage under the FEHB program if a state-issued birth certificate lists you as the parent of that child.
With one exception, there isn’t any requirement that your child be a student or live with you or even be financially dependent on you. Here’s the exception. To be eligible, a foster child must:
• be under age 26
• currently live with you
• have you as the primary source of financial support
• 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. Finally, you must sign a certified statement that your foster child meets all these requirements.
If a child meeting one of those definitions enters your life and you are not already enrolled in the FEHB, you may enroll. If you already are enrolled, you may increase from Self Only to Self Plus One or Self and Family, or from Self Plus one to Self and Family, and may change from one plan to another.
End of Child’s FEHB Eligibility
FEHB coverage under a parent’s enrollment ends at age 26; however, any of your children who reach that age can enroll in the Temporary Continuation of Coverage (TCC) provision for 36 months and pay the full premiums for that coverage.
Note: 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 under the Self Plus One or Self and Family option.
If you have no other family members eligible for coverage under your plan, you can switch to Self Only. If you still have one eligible family member, you can switch to Self Plus One. If you were enrolled in the Self and Family option and have at least three remaining family members to cover (including yourself), you can stay in that option.
FYI. You have from 31 days before your child turns 26 to 60 days after that date 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, you’ll have to notify OPM.
Coverage of Children under FEGLI
Upon the addition of a child or children, you may enroll in the Federal Employees’ Group Life Insurance program if not already enrolled. If you already are enrolled, you may elect additional coverage including newly electing or increasing an existing amount under Family option (“Option C”).
That option provides coverage on your spouse and eligible dependent children—in contrast to all other forms of FEGLI in which the enrollee is the person covered. It is available in between one and five multiples equal to $5,000 for your spouse and $2,500 for each of your eligible dependent children. You cannot elect a number of multiples for your spouse that is different from the number of multiples for your eligible children.
Eligible children include your natural children, adopted children, recognized natural children, and stepchildren and foster children if they live with you in a regular parent-child relationship. They must be dependent on you, unmarried and under age 22—or if age 22 or over, incapable of self-support because of a mental or physical disability that existed before the child reached age 22.
You receive any Option C benefits that become payable; you cannot designate a beneficiary.
Next time I’ll explain what you need to know about your Federal Employees Health Benefits and Federal Employees’ Group Life Insurance coverage if you are separated or divorced.