If you have or adopt a child, he or she is eligible for coverage under the Federal Employees Health Benefits program. Eligibility continues until age 26, with no cutoff for those incapable of self support because of a mental or physical disability that existed before age 26.
The definition of child includes adopted children, recognized natural children (born out of wedlock), and stepchildren. There is no general requirement that your child be a student or live with you or be financially dependent on you. An exception is that to be eligible, 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. Finally, you must sign a certified statement that your foster child meets all these requirements.
Whether you enroll the child under the self plus one option or self and family depends on your family situation.
What happens when a child (not meeting the definition of disability above) turns 26? You have from 31 days to 60 days after that point 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.)
(Note: You also may drop an eligible child who is under age 26, but 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; such a child also can request to be dropped on providing such proof; minor children may be dropped only under a court order. Most commonly this is done so that the children can enroll in health insurance offered by their own employers. In such situations you could downgrade coverage, for example from family coverage to self plus one.)
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 family option and have at least three remaining family members to cover (including yourself), you can continue your enrollment in the family option.
A child whose FEHB coverage ends on turning age 26 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.