OPM has issued a reminder to agencies of their authority to verify that family members being covered under the FEHB actually are eligible, including the process to be used and the documentation required.
The notice calls attention to a revision of the FEHB handbook section on family member eligibility reflecting several instructions of recent years, including one telling agencies to tighten scrutiny of those covered and another laying out procedures for removing those deemed ineligible. That is a response to several inspector general reports warning that ineligible persons are being insured under the program, raising premium costs to the government and to other FEHB enrollees.
That directive, now part of the handbook, lists agency responsibilities to verify eligibility of family members during initial enrollment of newly hired employees and when family members are being added to an existing enrollment due to a “qualifying life event” such as marriage.
It says agencies may require documentation such as a marriage license and proof of common residency for a marriage; a government-issued birth certificate for a child; an adoption certificate or decree for an adopted child; and a medical certificate of disability for a child age 26 or older who is incapable of self-support because of a condition arising before that age.
It includes sample letters for agencies to use in requiring such proof as well as sample letters for either affirming or denying coverage—in the latter case, with notice of rights to reconsideration.
OPM also updated the handbook to incorporate another directive on voluntarily removing family members who otherwise would be eligible. That could apply, for example, when adult children under age 26 become eligible for health care through another program such as through their own or a spouse’s employment.