Reg Jones Expert's View

Last week I wrote about the life and health benefits available to your children if you die. This week I want to focus on the health benefits available to the disabled children of deceased federal employees or retirees.

If you were enrolled in one of the Federal Employee Health Benefits (FEHB) plans when you died, your disabled child will continue to receive health benefits coverage if proper evidence of his or her disability is provided. For example:

• certification by a state or federal rehabilitation agency that the child is unemployable,

• receipt of survivor benefits from CSRS or FERS as a disabled child,

• receipt of benefits from Social Security or OWCP as a disabled child,

• a medical certificate documenting that the child is incapable of self-support, or

• other acceptable documentation.

If you were an employee, your spouse, a family member, or your representative will have to provide that information to your personnel office, which will determine if the criteria are met. If they are, it will let your FEHB plan know of its determination.

If you were retired, your widow(er) or family member will need to notify OPM, which will make the determination and provide it to your plan. If you have died and have no spouse, your legal representative will have to do that. Depending on the nature of the child’s disability, OPM may periodically ask for confirmation that the disabling condition still exists.

Survivor benefits and health benefits coverage of a disabled child will end if the child marries, recovers from the disability, becomes capable of self-support, or dies. However, the benefits may be restored if the marriage ends, the original disability returns, or the child is no longer capable of self-support.

The term “incapable of self support” generally means that the child earns less than the equivalent of GS-5, step 1. However, this is not an absolute measure of capability. When OPM makes a decision, it takes into account both the child’s earnings and his or her condition or prognosis.