Reg Jones Expert's View

Last week I wrote about the benefits available to the spouses of federal employees and retirees, and how to get your house in order so they’ll receive them. This time I’ll focus on the benefits available if a child enters your life.

Coverage under the FEHB program

According to OPM, children who qualify for Federal Employees Health Benefits coverage are those “under age 26, including adopted children, recognized natural (born out of wedlock) children and stepchildren (including children of same-sex domestic partners).”

There isn’t any requirement that your child be a student, live with you or, with one exception, be financially dependent on you. The exception applies to foster children. To qualify for coverage, a foster child, 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 and provide a certified statement that your foster child meets all these requirements.

 

Adding a child is a life event that allows you to increase coverage—to self plus one or to self and family, depending on your family situation.

 

As a rule, FEHB coverage for children can continue to age 26. However, there is one exception. If you have a child who is incapable of self support because of a mental or physical disability that existed before age 26, the coverage can continue indefinitely unless the child recovers or marries.

 

When coverage ends

With the exception noted above, FEHB coverage for children ends at age 26, You have from 31 days before to 60 days after that 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 (or 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 that option.

 

Temporary continuation of coverage

When your child’s 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. Since there won’t be any government contribution to the premiums, anyone electing TCC will be required to pay 100 percent of them, plus 2 percent for administrative expenses.

 

Next week I’ll explain what happens to your benefits if you separate from your spouse or your marriage ends in divorce.