Reg Jones Expert's View

Last week I wrote about the FEHB benefits available to federal employees, retirees, and their survivors. This time I want to focus on the health benefits due if a child enters your life.

A child is defined as one who is under age 26, including adopted children, recognized children born out of wedlock, and stepchildren. If you have a child, he or she is eligible for coverage under the FEHB program as long as a state-issued birth certificate lists you as the parent of that child. Whether you enroll the child under the Self Plus One option or Self and Family depends on your family situation.

With one exception, there isn’t any requirement that your child be a student or live with you to be covered under the FEHB program or be financially dependent on you. The exception is that a foster child must be under age 26, currently live with you; have you as the primary source of financial support, and enjoy a parent-child relationship with you, not with his or her biological parent(s). In addition, you must expect to raise the child to adulthood. Finally, you must sign a certified statement that your foster child meets all these requirements.

As a rule FEHB coverage for children ends at age 26. However, again there is an exception: if you have a child who is incapable of self support because of a mental or physical disability that existed before age 26, coverage continues.

You are required to inform your agency (OPM, if you are an annuitant) when a family member is no longer eligible for coverage. If you have no other family members eligible for coverage, you can switch to Self Only. If you have one other eligible family member, you can switch to Self Plus One. And if you were enrolled in the Self and Family option and have at least three remaining family members to cover (including yourself), you can continue your enrollment in the Self and Family option.

Note: A child whose FEHB coverage ends at age 26 will get a no-cost 31-day temporary extension of coverage and will be eligible to continue that coverage (or coverage in a another plan) under the temporary continuation of coverage provision for up to 18 months. Anyone electing TCC is required to pay 100 percent of the premiums, plus 2 percent for administrative expenses.

Next week I’ll focus on life insurance.