Healthcare & Insurance Healthcare

Eligibility

To enroll in FEHB coverage, you must be eligible under one of the following categories.

• Employees

  As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility.

  Full-time Temporary, Seasonal & Intermittent Employees

  You are eligible to enroll in an FEHB plan, if you are an

  • Employee on a temporary appointment who is expected to work 130 hours per month or more for at least 90 days;
  • Employee on a seasonal schedule who will be working a schedule of less than six months per year and are expected to work 130 hours per month or more for at least 90 days; or
  • Intermittent employee who is expected to work 130 hours per month or more for at least 90 days.

  You will receive the same government contribution as a full-time permanent employee.

  The FEHB Handbook provides additional information about employee eligibility and explains the special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

  Civilian Employees on Active Military Duty

  If you are a Federal employee enrolled in the Federal Employees Health Benefits (FEHB) Program and you enter one of the uniformed services for 30 days or less, your FEHB enrollment will continue without change. If you are placed on leave without pay for active military duty for more than 30 days, you may continue your coverage for up to 24 months or elect to have it terminate.

  Employees who serve in support of a contingency operation

  Your agency has the authority to pay the entire cost of your premium (including the employee share) for 24 months if you are called or ordered to active duty on or after September 14, 2001, and are:

  1. enrolled in an FEHB plan;
  2. a member of a reserve component of the armed forces;
  3. called or ordered to active duty in support of a contingency operation (as defined in section 101(a)(13) of title 10);
  4. placed on leave without pay or separated from service to perform active duty; and
  5. serving on active duty for a period of more than 30 consecutive days.

  Employees who do not serve in support of a contingency operation

  If you do not meet all of the above requirements of FEHB law, the authority for continuation of your FEHB coverage comes from the Uniformed Services Employment and Reemployment Rights Act (USERRA), now codified at section 4317 of title 38, United States Code.

  Your agency has no authority to pay your premiums while you are on military duty. You are responsible for the enrollee share of the premium during the first 12 months, and your agency will pay its share. For continued FEHB coverage for up to an additional 12 months, you are responsible for paying both the employee and agency shares of the premium, plus an additional 2% administrative fee.

  The FEHB Handbook provides additional information about FEHB coverage for Federal employees who are serving in the military.

  Temporary Firefighters

  Temporary firefighters and fire protection personnel working on wildland fires across the country are eligible for FEHB coverage. If you are part of the wildland firefighting force, you will have the option to enroll in FEHB coverage for yourself and your family with the option to convert your coverage to an individual contract or enroll in Temporary Continuation of Coverage when your employment ends.

  The Federal Employees Health Benefits (FEHB) Program Fact Sheet for Firefighters provides additional information.

• Annuitants and Survivor Annuitants

  Federal annuitants and their surviving spouses retain their eligibility for FEHB health coverage at the same cost as current employees. In order to carry your FEHB coverage into retirement, you must be entitled to retire on an immediate annuity under a retirement system for civilian employees (including the Federal Employees Retirement System (FERS) Minimum Retirement Age (MRA) + 10 retirement) and must have been continuously enrolled (or covered as a family member) in any FEHB plan(s) for the 5 years of service immediately before the date your annuity starts, or for the full period(s) of service since your first opportunity to enroll (if less than 5 years). The 5 year requirement period can include the following: the time you are covered as a family member under another person's FEHB enrollment; or the time you are covered under the Uniformed Services Health Benefits Program (also known as TRICARE) as long as you were covered under an FEHB enrollment at the time of your retirement.

  The pamphlet Information for Retirees and Survivor Annuitants, RI 79-2, summarizes the main FEHB requirements and benefits for Federal annuitants.

  The FEHB Handbook provides additional information about the special FEHB considerations for annuitants and compensationers.

  When you can suspend your coverage

  If you are a Federal annuitant, survivor annuitant, or former spouse who is TRICARE, TRICARE-for-Life, or CHAMPVA eligible, you can suspend your FEHB enrollment, and then reinstate your FEHB coverage during Open Season, or return to FEHB coverage immediately if you involuntarily lose this non-FEHB coverage.

  This flexibility allows you to avoid the expense of continuing to pay FEHB Program premiums while you are using the non-FEHB coverage, without endangering your ability to return to the FEHB Program in the future.

  Similarly, FEHB-covered annuitants, survivors, and former spouses who suspend FEHB coverage to enroll in a Medicare-sponsored plan, or in Medicaid or a similar State-sponsored program of medical assistance for the needy, may return to FEHB coverage during the annual Open Season or immediately upon being involuntarily disenrolled from the non-FEHB coverage.

• Family Members

  Family members eligible for coverage under your Self +1 or Self and Family enrollment include:

  • Your spouse, including a common law spouse only if the marriage was initiated in a state that recognizes such marriages,
  • Child under age 26 including
    • biological child,
    • stepchild,
    • adopted child, or
    • foster child; and
  • Child age 26 or older incapable of self-support, if disabling condition began before age 26.

  

  

  Child (Under age 26)

  • Biological Child
  • Stepchild
  • Married Child (excluding their spouse and kid)

  

  Adopted Child (Under age 26)

  • Placed for adoption
  • Financial responsibility exists

  

  Foster Child (Under age 26)

  • Parent-child relationship exists
  • Common residence
  • Expect to raise the child to adulthood
  • Primary source of financial support

  

  Spouse

  • Legally married
  • Initiated in a State that recognizes common law marriages

  

  Child incapable of self-support (Age 26 or older)

  • Incabale of self-support because of a physical or mental disability that existed before age 26 and will last for at least a year

  

  Click on a category in the circle to learn more.

  Note: This infographic is for the purpose of providing general information about FEHB rules. It does not replace official guidance.

  Your employing office will review the evidence you provide to determine whether your family member is eligible for coverage.

  The FEHB Handbook and FAQs provide additional information about family members' eligibility for coverage.

  Spouse

  Your spouse is an eligible family member.

  You must provide proof that you are legally married to your spouse.

  • If you are married less than 12 months, provide a copy of your government-issued marriage certificate.
  • If you are married 12 months or more, provide a copy of your government-issued marriage certificate and any one of the following sets of documents listing your spouse:
    • Front page of most recent tax year’s Federal or State tax return; or
    • Proof of common residency (e.g., utility bill, other household bill, auto registration); and proof of financial interdependency (e.g., shared bank statement, credit card statement, life or auto insurance policy).

  The FEHB Family Member Eligibility Factsheet for Spouse summarizes the eligibility requirements.

  Common Law Spouse

  You may cover your common law spouse under the FEHB Program only if your marriage was initiated within a State that recognizes such a marriage. The National Conference of State Legislatures lists the states that recognize common law marriages. You must provide all of the following information:

  • A court order or judgment recognizing the marriage; or
  • Your declaration indicating:
    • The date on which and the state in which you and your spouse mutually agreed to become married.
    • The length of time you and your spouse have lived together.
    • All address or addresses at which you and your spouse have lived together.
    • Whether you and your spouse have been regarded among neighbors, friends, and relatives as being married spouses.
    • If you or your spouse were previously married, the declaration must indicate date and place of each previous marriage as well as the date, place, and manner of termination (i.e., death, divorce, or annulment).
    • Your signature underneath the following statement:
      • WARNING: Any intentionally false statement or willful misrepresentation relative thereto is a violation of the law punishable by a >fine of not more than $10,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 1001)

  In addition to the above, you must provide any one of the following documents listing you and your spouse:

  • Front page of most recent tax year’s Federal or State tax return; or
  • Proof of common residency (e.g., utility bill, other household bill, auto registration); and proof of financial interdependency (e.g., shared bank statement, credit card statement, life or auto insurance policy).

  The FEHB Family Member Eligibility Factsheet for Common Law Spouse summarizes the eligibility requirements.

  Child under age 26

  Child under age 26 includes your biological child, stepchild, legally adopted child, and foster child.

  Your biological child meets the eligibility requirements when you provide a copy of any one of the following documents listing you and your child:

  • Government-issued birth certificate; or
  • Certificate of live birth; or
  • Front page of the most recent tax year’s Federal or State tax return; or
  • Consular Report of Birth Abroad; or
  • Official paternity test; or
  • Voluntary affidavit of paternity or similar document; or
  • Court or administrative order (e.g., National Medical Support Notice).

  You can establish your relationship with your stepchild by providing a copy of any one of the following documents:

  • Birth certificate, or final adoption certificate/decree, listing current spouse as parent; or
  • Front page of most recent tax year’s Federal or State tax return with child’s name; or
  • Court or administrative order (e.g., National Medical Support Notice).

  Note: If enrolling a stepchild, you must also verify your spouse’s eligibility (see above for required documents), even if you are not enrolling your spouse on your FEHB plan.

  The FEHB Family Member Eligibility Factsheet for Child Under Age 26 summarizes the eligibility requirements.

  Adopted Child

  A child is considered adopted when the child is placed for adoption with you. In other words, you have assumed legal responsibility for total or partial support of the child in anticipation of adoption.

  You must provide a copy of any one of the following documents listing you and your child:

  • Final adoption certificate or decree; or
  • Authorized letter from a placement agency for the purpose of adoption; or
  • Front page of most recent tax year’s Federal or State tax return with child’s name; or
  • Court or administrative order (e.g., National Medical Support Notice).

  The FEHB Family Member Eligibility Factsheet for Adopted Child summarizes the eligibility requirements.

  Foster Child

  Your foster child is eligible for coverage if they meet the following requirements:

  • the child must be under age 26 (if the child is age 26 or over, he/she must be incapable of self-support on account of a disabling condition that began 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.

  You must submit all of the following documents:

  • Certification of foster child status that is available in the FEHB Handbook.
  • Government-issued birth certificate or other document verifying child’s date of birth
  • Documentation of regular and substantial support for the child such as:
    • Evidence of eligibility as a dependent child for benefits under other State or Federal programs
    • Proof of inclusion of the child as a dependent on the front page of the enrollee’s most recent tax year’s Federal or State income tax returns
    • Canceled checks, money orders, or receipts for periodic payments from the enrollee for or on behalf of the child
    • Evidence of goods or services which show regular and substantial contributions of considerable value
    • Any other evidence which OPM, in guidance, deems to be sufficient proof of support
  • If applicable, include copy of court order naming employee or spouse as child’s legal guardian

  The FEHB Family Member Eligibility Factsheet for Foster Child summarizes the eligibility requirements.

  Child Incapable of Self-Support

  Your child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. You must submit a medical certificate stating the child is incapable of self-support because of a physical or mental disability that existed before they became age 26 and is expected to continue for more than one year. Additional information required to be included in the certification can be found in the FEHB Handbook.

  The FEHB Family Member Eligibility Factsheet for Child Incapable of Self-Support summarizes the eligibility requirements.

• Temporary Continuation of Coverage (TCC)

  Temporary Continuation of Coverage is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. As a TCC enrollee, you must pay the full premium for the plan you select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative fee.

  The TCC pamphlet and FEHB Handbook provide additional information about TCC.

  Former Spouses

  Under the Civil Service Retirement Spouse Equity Act of 1984, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the FEHB Program.

  The FEHB Handbook and FEHB FastFacts for Former Spouse provide additional information about former spouse eligibility for coverage.