Q. Who can be covered by my FEHB enrollment?
A. FEHB Program coverage is available for the employee's current spouse and children under age 26, including legally adopted children, stepchildren and recognized natural children born out of wedlock. Foster children (including grandchildren, if they qualify as foster children) are included if they live with the employee in a regular parent-child relationship. Also, a child age 26 or over who is incapable of self support because of a mental or physical incapacity which existed before age 26 may qualify for coverage under certain conditions. You cannot cover other relatives, such as your mother, even if they are otherwise considered your dependents.
An employee's agency makes enrollment eligibility decisions in accordance with the law and regulations. Ask your Human Resources Office for help in deciding whether your circumstances meet the requirements.
Q. I just had a baby. My coworker just adopted a child. Do either of us
need to complete another SF 2809, Health Benefits Registration Form,
to have our children covered?
A. How you acquire a child (e.g., birth or adoption) does not matter. If you have Self Only enrollment, you each need to complete an enrollment form to change to a Self and Family enrollment within 60 days of the event. The Self and Family enrollment will be effective the first day of the pay period in which the child was born or adopted. If you already have a Self and Family enrollment, you do not need to complete a new form; in this case, contact your plan to let them know about the new family member.
Q. My child is in college. How long can my child stay covered under my enrollment?
A. Your child can be covered under your Self and Family enrollment until he or
she turns age 26. It does not matter whether he or she attends
college.
Q. My child will be 26 years old this year but she is disabled and incapable of self support. Can I continue to cover her under my FEHB enrollment?
A. Your child age 26 or over who is incapable of self-support because of a disability that existed before age 26 may be eligible for coverage under your FEHB enrollment. For more information, please see the FEHB Handbook for Enrollees and Employing Offices.
Q. Can I cover my common-law spouse under my Self and Family enrollment?
A. If the State in which you reside recognizes common-law marriages, yes.
Q. Can my grandchild be covered by my plan?
A. Your grandchild may be eligible for FEHB coverage if he or she meets the eligibility requirements for foster children. These requirements are:
- the child must be under age 26 (if the child is over age 26, he/she must be incapable of self support);
- the child must live currently with you;
- the parent-child relationship must be with you, not the child's biological parent;
- you must currently be the primary source of financial support for the child; and
- you must expect to raise the child to adulthood.
For your grandchild to be covered under your FEHB enrollment, you must sign a
certification stating that your grandchild meets all the requirements and that
you will notify your employing office if the child moves out of the
home, or stops being financially dependent on you. You submit this certification
to your employing office for their determination that your grandchild meets
these requirements. Your employing office will then notify your FEHB plan that
your grandchild should be added to your enrollment.
Q. Is my same-sex partner eligible for coverage under my FEHB enrollment?
A. No. The law defines family members as a spouse and child under age 26. Public Law 104-199, Defense of Marriage Act, states, " the word 'marriage' means only a legal union between one man and one woman as husband and wife, and the word 'spouse' refers only to a person of the opposite sex who is a husband or a wife."
Q. My ex-spouse is a Federal employee. I have a court order stating that
he has to provide health insurance coverage for our children. How can I
make sure his health plan covers the children?
A. The "Federal Employees Health Benefits Children's Equity Act of 2000"
requires mandatory Self and Family enrollment coverage for FEHB-eligible
employees who do not comply with a court or administrative order to provide
health insurance coverage for their child(ren). You should send a copy of
the court order to your spouse's Human Resources Office. They will ensure
that your ex-spouse is enrolled in a Self and Family FEHB plan that provides coverage for the children.
If he is not enrolled in a Self and Family plan, his Human Resources Office will
enroll him in the Self and Family plan of his current FEHB plan. If his current
plan is an HMO and the child(ren) don't live within the service area of this plan,
they will enroll him in the Basic Option of the Blue Cross and Blue Shield
Service Benefit Plan. Please be sure to include your home address in your
notification so that the Human Resources Office can make this determination.
The Human Resources Office will send you a copy of the SF 2809, Health
Benefits Election Form. They will also send a copy to the FEHB plan so the plan
can update their records and send ID cards to you. The Human Resources
Office will flag your ex-spouse's health insurance records to prevent him from
making a change to the Self Only plan for as long as the court order requires him
to provide health insurance coverage to your child(ren) or until age 26,
whichever occurs first.
Q. My spouse got a court order requiring me to provide health insurance
coverage for our children although I am already enrolled in a self and
family plan. Do I have to do anything?
A. Yes. You should still send a copy of the court order to your Human Resources
Office to review and make a determination if any action is required. They will file the copy in your OPF and flag it so that they know a court order relating to health benefits has been filed. If your children aren't listed as family members on the SF 2809, they will send a copy of the court order to your FEHB plan.