Reg Jones Expert's View

Last week I wrote about the benefits available to those federal employees who move from single to married status. This time I want to focus on the benefits due when a child enters your life.

The main benefit of interest is health insurance, of course, and the first question is this: Who qualifies as a child? According to OPM, these are children under age 26, including adopted children, recognized natural (born out of wedlock) children, stepchildren, and foster children who meet the criteria described below. If you have a child, he or she is eligible for coverage under the Federal Employees Health Benefits program if 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.

To be covered under the FEHB program, there is no requirement that your child be a student or live with you or, with one exception, be financially dependent on you. Here’s the exception. To be considered a foster child, he or she must:

* be under age 26
* currently live with you
* have you as the primary source of financial support
* enjoy a parent-child relationship with you, not with his or her biological parent(s)

Further, you must expect to raise the child to adulthood. Finally, you must sign a certified statement that your foster child meets all these requirements.

FEHB coverage for children can continue to age 26 when, with rare exception, it ends. Here’s the rare exception. If you have a child who is incapable of self support because of a mental or physical disability that existed before age 26, that FEHB coverage can continue without interruption.

You have from 31 days before your child turns 26 to 60 days after to make the enrollment change. It’s up to you to let your agency know when a family member is no longer eligible for coverage. (OPM if you are an annuitant.) 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.

By the way, all if not lost for a child whose FEHB coverage ends at age 26. He or she will get a no-cost 31-day temporary extension and be eligible to extend that coverage under the Temporary Continuation of Coverage provision for up to 18 months. Anyone electing TCC will be required to pay 100 percent of the premiums, plus 2 percent for administrative expenses.

Other benefit considerations are:
Life Insurance–An employee who acquires an eligible child has 60 days from the date of the event to elect Basic, plus any or all optional insurance: Option A, Option B (up to the maximum), and Option C (up to the maximum).
This includes the birth or adoption of a child, placement of a foster child, a stepchild or recognized natural child moving in with the employee, the end of a marriage of an otherwise eligible child who lost that eligibility due to marriage, or the employee gaining custody of an eligible child.
Federal Dental and Vision Insurance Program–On the birth or adoption of a child, a Federal Dental and Vision Insurance Program enrollee may increase coverage from self-only to self plus one or to self and family, or from self plus one to self and family, although initial enrollment is not allowed, nor is cancellation or changing from one plan to another. The election must be made between 31 days before to 60 days after the event.
Flexible Spending Accounts–The birth or adoption of a child is a qualifying status event allowing changes in allotments to flexible spending accounts from 31 days before the event to 60 days after.