OPM has issued rules aimed at removing ineligible family members from coverage under the FEHB program, saying that it estimates that 1-3 percent of persons covered as spouses and 4-12 percent of those covered as children actually are ineligible under the program.
The proposal in Tuesday’s Federal Register, effective after 30 days, combines two prior separate proposals. One aspect will require “that proof of family member eligibility must be provided upon request by a carrier, employing office, or OPM. This regulation does not require agencies to track family members, but forthcoming subregulatory guidance may require agencies to collect proof of eligibility in certain circumstances.” It also lays out procedures for removing a person found to be ineligible.
The second policy change will allow, under certain circumstances, voluntary removal from coverage of family members who are eligible, allowing for the enrollee to downgrade to a less expensive type of enrollment, for example from family coverage to self plus one or from self plus one to self-only.
With the consent of both spouses, an enrollee could drop a covered spouse so that the spouse could enroll in health insurance sponsored by his or her own employer. Similarly, the rule would allow the enrollee to drop the child by providing proof that the child is no longer a dependent; the child also could request to be dropped on providing such proof. Under current policy, children up to age 26 must be covered under a parent’s self plus one or family enrollment even if the now-adult child has access to health insurance through his or her own employment–but if the adult child is married, FEHB coverage does not extend to his or her own spouse or children.