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Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered under a Self and Family enrollment. Your child must be under age 26 or be incapable of self-support because of a mental or physical disability that existed before age 26.
Your children cannot be covered under more than one FEHB enrollment. If your former spouse (the Federal employee or annuitant) covers the children under his/her FEHB enrollment, your Spouse Equity enrollment should be for Self Only coverage.
If you are a surviving child of the enrollee and the enrollee also has a surviving spouse or child eligible to receive a CSRS or FERS survivor annuity benefit, you can be covered under the survivor annuitant’s Self Plus One enrollment (if you were the designated eligible family member) or Self and Family enrollment until age 26. You can continue coverage beyond age 26 if you are incapable of self-support because of a mental or physical disability that existed before age 26.
If you are a surviving child of the enrollee and you are eligible for a CSRS or FERS survivor annuity benefit and the enrollee has no other survivors, the enrollment will be changed to a self only enrollment in your name. You will be responsible for paying the premiums either by having them withheld from your survivor annuity or through direct billing. You can continue this FEHB coverage until your survivor annuity ends at age 18, or age 22 if you are a full-time student. You can continue coverage beyond age 18 if you are incapable of self-support because of a mental or physical disability that existed before age 18. Your coverage will continue for 31 days after eligibility ends, unless the enrollment is cancelled. During that time, you may enroll in Temporary Continuation of Coverage (TCC) or convert to an individual policy offered by your FEHB plan.
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.
The "Federal Employees Health Benefits Children's Equity Act of 2000" requires mandatory Self Plus One or 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 ex-spouse's Human Resources Office. They will ensure that your ex-spouse has an FEHB Self Plus One or Self and Family enrollment that provides coverage for the children. If your ex-spouse does not have a Self Plus One or Self and Family enrollment, his or her Human Resources Office will enroll him or her in the Self Plus One or Self and Family option of his or her current FEHB plan. If his or her 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. If he or she is enrolled in Self Plus One but does not have the child listed in the court order designated as his or her covered famiy member, the Human Resources Office will increase his or her enrollment to Self and Family.
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 or her from decreasing his or her enrollment or switching his or her covered family member under a Self Plus One enrollment for as long as the court order requires him or her to provide health insurance coverage to your child(ren) or until the youngest child reaches age 26, whichever occurs first.
As a result of health care reform, beginning January 1, 2011, children of Federal enrollees will be covered by their parent’s FEHB Self Plus One enrollment (if the child is listed as the designated covered family member) or the parent’s FEHB Self and Family enrollment until their 26th birthday (plus a 31-day temporary extension of coverage), even if the child previously lost coverage because he/she turned 22.
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