Expert's View

The Federal Employees Health Benefits program offers two options when it comes to coverage. You can either elect “self only” or “self and family.” Who is covered by the former is obvious – it’s you, as the enrollee. Less clear is who is covered under the second option. So, let’s spend a few minutes reviewing who can legitimately be considered a member of your “family.”

According to OPM, family members who are eligible for coverage under your FEHB enrollment are your spouse (including a valid common law marriage) and any unmarried dependent children under age 22. The definition of dependent children includes legally adopted children and recognized natural children born out of wedlock, as long as they meet certain dependency requirements. Step children and foster children are also included if they live with you in a regular parent-child relationship. However, grandchildren are not considered eligible family members unless they qualify as foster children.

You’ll note that the word “dependent” occurs frequently in the definition of who is an eligible family member. Essentially, this means that you are financially responsible for them. In the case of natural, step, and foster children, more proof of dependency may be required. For example, evidence of eligibility as a dependent child under other state of federal programs, proof that you included the child as a dependent on your tax returns, canceled checks, money orders, or receipts that were made on behalf of the child, etc.

There’s one other category of dependency that is important to many of you. If you have children who are unmarried and incapable of self support due to disabilities that occurred before age 18, they may remain under your self and family coverage as long as they remain unmarried and do not become capable of self support.