Reg Jones Expert's View

If you are enrolled in the self only option of a Federal Employees Health Benefits plan, you can stop reading now. However, if you are enrolled in a self and family option, it would be worth your while to read on. That’s because OPM is conducting an audit to determine if there are any erroneous enrollments of family members in the FEHB program. So, the big question for you is this: Who is a family member? I’ll get to that in a moment. First, the basics.

If you are enrolled in the self and family option of an FEHB plan, it provides benefits for you and your eligible family members, even if you forgot to list them on your Standard Form 2809, Employee Health Benefits Registration Form. What this means is that you can’t exclude any eligible family member. It also means that you can’t provide coverage for anyone who isn’t a family member.

By law, an “eligible family member” includes:

* your spouse, including a common law marriage recognized in your state of residence or a same-sex spouse married in a jurisdiction (including a foreign country) that recognizes such marriages, regardless of your state of residence;

* a former spouse under certain conditions;

* children under age 26, including legally adopted children, recognized children born out of wedlock, stepchildren and, in certain circumstances as explained below, foster children;

* children of any age if incapable of self support because of a mental or physical disability that began before age 26; and

* children of a same-sex domestic partner under certain circumstances as explained below.

With a barn door that wide open, it’s hard to figure out who would be ineligible to be covered in the FEHB program. Still, there are some exclusions.

For example, domestic partnerships, civil unions or other arrangements that aren’t formally recognized as a marriage don’t fit the definition of an eligible family member. However, if you are in a same-sex domestic partnership that meets certain qualifications and are living in a jurisdiction that doesn’t recognize same-sex marriage, the child or children of your partner are eligible for coverage—but only if you certify that you would marry your partner were the option available in your state of residence. The partner himself or herself is not eligible even then, though.

Also, there are certain conditions that control the eligibility of stepchildren and foster children. For example, as an enrollee, your stepchildren remain eligible after a divorce, a domestic partnership ends, or your spouse or domestic partner dies, as long as the children continue to live with you in a regular parent-child relationship.

To be eligible as a foster child, the child must live with you and you must be the primary source of financial support for the child and expect to raise the child to adulthood. Further, you must sign a certification stating that your foster child meets those requirements.