Domestic partnerships, civil unions or other arrangements that aren’t formally recognized as a marriage don’t fit the definition of an eligible family member. Image: Palto/Shutterstock.com
By: FEDweek StaffIt’s more important now than ever for federal employees and retirees to know the rules on who qualifies as an eligible family member under FEHB and PSHB health insurance.
Attention to that issue has been building in light of reports by the GAO and OPM’s inspector general of ineligible persons being carried, at an additional cost in premiums (about 30 percent of which enrollees pay). That led Congress earlier this year to conduct a full scrub of enrollment—while, crucially, providing additional money to do so—which could start seeing results in the months ahead. However, funding for that effort was not provided to bring the FEHB into the portal developed for PSHB for verifying eligibility going forward, and documenting eligibility remains decentralized and difficult. That increases the possibility of ineligible dependents to remain covered for an unknown period.
That law didn’t specify consequences for enrolling ineligible persons, but there’s no question that being discovered as having done so carries a financial risk. That’s true even for persons you consider family members—who even may be living with you.
By law, an eligible family member includes:
- your spouse;
- a former spouse under certain conditions;
- children under age 26, including legally adopted children, recognized children born out of wedlock, stepchildren and, in certain circumstances as explained below, foster children;
- children of any age if incapable of self-support because of a mental or physical disability that began before age 26.
Domestic partnerships, civil unions or other arrangements that aren’t formally recognized as a marriage don’t fit the definition of an eligible family member. Nor do parents, brothers and sisters and other close relatives, even if they are dependent on and/or living with you.
Also, there are certain conditions that control the eligibility of stepchildren and foster children. For example, as an enrollee, stepchildren remain eligible after a divorce or your death, as long as the children continue to live with you in a regular parent-child relationship.
To be eligible as a foster child, the child must live with you and you must be the primary source of financial support for the child and expect to raise the child to adulthood. Further, you must sign a certification stating that your foster child meets those requirements.
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See also,
Calculating Service Credit for Sick Leave At Retirement
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How Your FERS, Social Security and TSP Payments Get Taxed
