Last week we looked at the benefits available if you get married and how to make adjustments in your designations of beneficiaries – now let’s turn to federal benefits available to you change when a child enters your life – focusing on FEHB.
First off is the question of who is a qualifying child. You’d think that answering that would be simple. But this is the government, so it isn’t.
According to the Office of Personnel Management, the definition of child includes the following: children under age 26, including adopted children, recognized natural children born out of wedlock, stepchildren (including children of same-sex domestic partners), and foster children. And there’s one more wrinkle. If you have a child, he or she is only eligible for coverage under the FEHB program if a state-issued birth certificate lists you as the parent of that child.
While there’s usually no requirement that your child be a student or live with you or be financially dependent on you, there’s one exception. To be considered an eligible 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)
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.
Upon the addition of a qualifying child, if you are enrolled you can change your enrollment (such as from self only to self plus one or to self and family) or change your enrollment to another FEHB plan or option. If you are a current employee who is not enrolled, you may do so and pick the coverage you want. However, retirees may not newly enroll.
When a Child’s Coverage Ends
When FEHB coverage under a parent’s enrollment ends, most commonly on turning at age 26, children can maintain coverage for 36 months under the temporary continuation of coverage feature, although they must the full premiums (personal and government share) plus a 2 percent administrative fee. Note: If you have a child who is unmarried and incapable of self-support because of a mental or physical disability that existed before age 26, that coverage can continue without interruption.
If you have no other family members eligible for coverage under your own plan, 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 two family members to cover (other than yourself), you can continue your enrollment in the self and family option.
You have from 31 days before to 60 days after your child turns 26 to make any change in your own coverage. If you are an employee, it’s up to you to let your agency know when a family member is no longer eligible for coverage under your enrollment. If you are a retiree, you’ll have to notify OPM.
Note: Under certain circumstances voluntary removal from coverage of an eligible family member is allowed, primarily for the family member to enroll in health insurance sponsored by his or her own employer. An enrollee may drop an eligible child who is past the age of majority in the jurisdiction of the child’s residence (commonly 18) by providing proof that the child is no longer a dependent; the child also can request to be dropped on providing such proof. In such situations the enrollee may downgrade coverage, for example from family coverage to self plus one.
The rules for the Federal Dental and Vision Insurance Program generally are the same with the main exceptions that: children must be unmarried, dependent and under age 22 (unless disabled) to be covered; there is no continuation of coverage provision for those who lose eligibility; and retirees may newly enroll upon the addition of a child.
Also, on the addition of a child you may newly enroll or add to existing coverage in the FEGLI life insurance program.
More at ask.FEDweek.com