Issue Briefs

Following is a new summary OPM has issued on eligibility of family members under the FEHB program and the requirements for documenting their eligibility.


Is my spouse an eligible family member for FEHB?

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Eligibility

Your spouse who you are currently married to is eligible for FEHB coverage.

Note: If you are in a common law marriage, please see the fact sheet for common law spouses.

Example: You retired over twenty years ago and are covered under FEHB. You are in love and are planning to get married. When you get married, your new spouse will be an eligible family member for FEHB.

Example: Your long-time partner who lives with you doesn’t have health insurance. You want to add your partner to your FEHB plan. Your partner is not an eligible family member on your FEHB plan. Only legally married spouses are eligible for FEHB coverage.

Eligibility Documents

You must provide a copy of your official marriage certificate to prove that you are legally married to your spouse.

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If you’ve been married for 12 months or more, then you must also show that you and your spouse are both listed on one of the following:

The first page of your most recent tax return, or

Proof of common residency and proof of combined finances.

Is my common law spouse an eligible family member for FEHB?

Eligibility

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A common law marriage must be initiated in a state that recognizes common law marriages for the marriage to be valid. If you are in a valid common law marriage, then your spouse is eligible for FEHB coverage. The National Conference of State Legislatures lists the states that recognize common law marriages.

Example: You and your partner live together in Texas where your partner is recognized as your common law spouse. You relocate to Maryland where common law spouses are not recognized. Since your common law marriage commenced in a state that recognizes common law marriages, your partner is an eligible family member under your FEHB plan.

Example: After dating for a year, you take the next step and start living together with your partner. You want to add your partner to your FEHB plan. Your partner is not an eligible family member on your FEHB plan since you are not in a valid common law marriage.

Eligibility Documents

You must provide the following documents to prove your common law spouse’s eligibility:

A court order or judgment from the initiating state recognizing the marriage; or

Your signed declaration. Consult your employing office for details about what the declaration should include.

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You must also provide one of the following documents that list you and your spouse:

The first page of your most recent tax return;

Proof of common residency and proof of combined finances.

Is my child an eligible family member for FEHB?

Eligibility

Your child under the age of 26 is eligible for FEHB coverage if they are your:

Biological child,

Stepchild, or

Married child (but not the child’s spouse or kids).

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Example: Your new spouse has a twenty-three-year-old son. You want to add him to your FEHB plan. Your step-child under the age of 26 is an eligible family member for FEHB.

Example: Your partner has a twelve-year-old daughter from a prior relationship who does not live with you. You want to add your partner’s daughter on your FEHB plan. Since you are not the stepparent to your partner’s child, you cannot add the child to your FEHB plan.

Eligibility Documents

You must provide a copy of one of the following documents that lists you and your child:

Official birth certificate;

Certificate of live birth;

The first page of your most recent tax return;

Consular Report of Birth Abroad;

Official paternity test;

Voluntary affidavit of paternity or similar document; or

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Court or administrative order (for example, a National Medical Support Notice).

Note: In the case of a stepchild, the birth certificate must list your current spouse as parent, and you must also verify your spouse’s eligibility even if you are not enrolling your spouse.

Is my adopted child an eligible family member for FEHB?

Eligibility

Your adopted child under the age of 26 is eligible for FEHB coverage once the child is

Placed for adoption with you and

You take legal responsibility for financial support.

Example: You routinely help your struggling neighbor by caring for his son. You see the boy as your adopted child and want to add him to your FEHB plan. Since the child has not been placed for adoption with you, this child is not an eligible family member for FEHB.

Example: After years of waiting, a child is finally placed for adoption with you. When you take financial responsibility for the child, your adopted child will be an eligible family member for FEHB.

Eligibility Documents

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You must provide a copy of one of the following documents that lists you and your child:

Final adoption certificate or decree;

Authorized letter from an adoption placement agency;

The first page of your most recent tax return; or

Court or administrative order (for example, a National Medical Support Notice).

Is my foster child an eligible family member for FEHB?

Eligibility

Your foster child under age 26 is eligible for FEHB coverage. This means that:

You must have a parent-child relationship with the child.

You must be the child’s primary source of financial support.

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You must live with the child and expect to raise the child to adulthood.

Example: You live with and support a child whose parents died and is a close relative of yours. This child qualifies as your foster child for FEHB.

Example: Your foster child turns 18 and moves into her own apartment. Since she doesn’t live with you, she is not eligible for FEHB coverage on your plan.

Eligibility Documents

You must provide all of the following documents to prove eligibility:

Certification of foster child status; and

Documentation that shows you provide regular and significant financial support for the child such as:

State or Federal benefits programs listing the child as your dependent.

The first page of your most recent tax return listing the child as your dependent.

Canceled checks, money orders, or receipts for periodic payments from you for or on behalf of your child.

Your child’s official birth certificate.

Note: You may also include a copy of a court order naming you or your spouse as the child’s legal guardian, if applicable.

Is my adult disabled child an eligible family member for FEHB?

Eligibility

Your disabled child over the age of 26 who is incapable of working at a self-supporting job because of a physical or mental disability is eligible for FEHB coverage if your

Child’s physical or mental disability existed before the age of 26; and your

Child’s disability is expected to continue for at least a year.

Example: Your son became partially paralyzed after a car accident several years ago and he is only eligible for part-time work which does not cover his annual expenses. He turns 26 years old next month. He can stay on your FEHB plan as a child incapable of self-support.

Example: Your daughter struggles to hold down a job. She lives with you and depends on you financially. Her 26th birthday is next month. Your daughter is not eligible to stay on your FEHB plan when she turns age 26.

Eligibility Documents

You must provide a medical certificate stating:

The child is incapable of self-support because of a physical or mental disability that existed before they became age 26, and

The disability is expected to continue for more than one year.

You can find additional information about what to include in the certification in the FEHB Handbook.

Note: Your employing office will determine how long your child is eligible to stay on your FEHB enrollment.

Frequently Asked Questions

Q.Is my ex-spouse eligible for coverage under my FEHB plan?

A. No, your ex-spouse’s eligibility to stay on your FEHB coverage ends the day your divorce is finalized.

Q. My son turns 26 next month. Can I keep him on my FEHB enrollment?

A. No, a child over the age 26 is not eligible to stay on your FEHB plan unless they are incapable of self-support.

Q. My mother lives with me. Can I cover her under my FEHB plan?

A. No, parents are not eligible family members for FEHB.

Q. What do I do if one of my family members is no longer eligible?

A. You must notify your employing office within 60 days of a family member becoming ineligible. Your employing office will inform your family member of their option to enroll in FEHB for themselves. In addition, you may also have the opportunity to change your plan or enrollment type.

Q. What option does my ex-spouse or child who is now 26 years old have in getting FEHB coverage?

A. Your family members who are no longer eligible on your FEHB plan may be eligible for Temporary Continuation of Coverage (TCC). TCC allows your family members to continue FEHB coverage for up to 36 months after their coverage ends on your enrollment.

Q. Which family members are not eligible for FEHB?

A. The family members who are not eligible for FEHB include:

Grandchildren

Parents

Siblings

In-laws

Q. What should I do if I determine that my family member is eligible?

A. You should contact your employing office for guidance on next steps.

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