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Frequently Asked Questions Insurance

Coverage for Family Members

  • Only you and the children born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered.
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  • As long as you have a Self and Family enrollment and one of the family members is entitled to a survivor annuity, the children are eligible for FEHB coverage until they reach age 26 or until no survivor is eligible for a survivor annuity. Children age 26 or over are eligible to continue FEHB coverage if they are incapable of self-support because of a mental or physical disability that existed before age 26. 
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  • No, premiums that are paid under TCC are not eligible for premium conversion. Although we realize that you may make the premium payments on behalf of your child, the TCC policyholder is the child. 
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  • If you are an annuitant or an employee who waived premium conversion, you can change from a Self and Family enrollment to a Self Only enrollment at any time. If you are an employee, your youngest child turning age 26 is a qualifying life event (QLE) permitting you to change your FEHB enrollment outside of Open Season.  With this QLE, you can change from Self and Family to Self Only coverage.  You do not need to wait until the next Open Season to make this change; however, you need to request the change to Self Only coverage within 60 days of your child turning 26.
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  • The TCC provisions allow children who no longer qualify as an eligible child (e.g., child reaches age 26, foster child no longer lives with the employee, foster child is no longer financially dependent on the employee) to continue their FEHB coverage for up to 36 months. The child is enrolled in his/her own right and pays both the employee’s and the Government's share of the premium, plus an additional 2% administrative cost. You should notify your employing office within 60 days after the child no longer qualifies for coverage as a family member. A child who loses FEHB coverage for any reason other than by cancellation has a 31-day temporary extension of coverage, at no cost, for the purpose of converting to a non-group contract with his/her current health benefits plan. To convert the child's coverage to a non-group plan, you or your child must apply directly to the health benefits plan within 31 days after the child's eligibility ends. For further information on health benefits, contact your personnel office.
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  • Your grandchild may be eligible for FEHB coverage if he/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 due to a disability that existed before age 26);
    • the child must currently live 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.
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  • 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.
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  • Your plan's premiums will not decrease due to your family getting smaller, just as the premiums did not increase because you added children and your family grew. Federal law permits you to choose between two options: a Self Only enrollment or a Self and Family enrollment. Other coverage types such as Self and Spouse, Self and One Child (or two children, three children, etc.), and Self Plus One are not permitted under Federal Employees Health Benefits (FEHB) law.
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  • Your child is covered under your Self and Family enrollment until age 26. There is no ‘live with’ requirement other than for foster children.  If you are enrolled in an HMO, your child will only be covered for emergency care while outside the HMO’s service area.  If your child is living outside your HMO’s service area, you may want to change to an FEHB plan that provides coverage both where your child is living and where the rest of your family is living.  Your plan brochure describes your HMO’s service area.  You can download your plan brochure by clicking on your state. Foster children must live with you and meet all of the requirements below:
    • the child must be under age 26;
    • the employee must be the primary source of financial support for the child;
    • the parent-child relationship must be with the enrollee, not the child's biological parent; and
    • the employee must expect to raise the child into adulthood.
    You must sign a certification stating that your foster child meets all the requirements. Contact your agency or Retirement System for more information.
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  • For an adopted child, FEHB coverage ends when the child reaches age 26.  Health benefits can continue after age 26 if the child is incapable of self-support because of a mental or physical disability that existed before age 26. Contact your employing office for information on how to continue coverage in such cases. For a foster child, health benefits stop when any one of the following requirements is no longer met:
    • the child must be under age 26 (if the child is over age 26, he/she must be incapable of self support due to a disability that existed before age 26);
    • the child must currently live 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.
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