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Insurance FAQs

Coverage for Family Members

  • When children reach age 26, they are eligible to enroll in Temporary Continuation of Coverage (TCC) or convert to an individual policy.  It is the responsibility of you or your child to know when he/she is no longer eligible for coverage and to apply for TCC or a conversion policy in a timely manner. Your employing office is not obligated to inform you of your child’s eligibility for TCC and conversion rights when he/she is no longer eligible for coverage. TCC: If a child loses coverage under your enrollment because he/she reaches age 26, he/she is eligible for TCC. You must contact your Human Resources Office within 60 days of your child’s 26th birthday to inform them that your child is turning age 26.  Your Human Resources Office will give you information about enrolling your child in TCC or converting your child to an individual policy.  Your child has 60 days to request enrollment for TCC from the later of (1) his/her 26th birthday or (2) the date of the TCC notice from the Human Resources Office. For more information about TCC, please review the TCC coverage pamphlet at www.opm.gov/insure/health/eligibility/tcc. Conversion: If a child loses coverage under your enrollment because he/she reaches age 26, he/she is entitled to convert to an individual policy offered by the carrier of your plan. Your child is not required to provide evidence of insurability.  To apply for conversion, you or your child must make a written request to the carrier of your plan.  You or your child must apply for conversion within 31 days after his/her 26th birthday.  For more information about conversion, please visit http://www.opm.gov/insure/health/reference/handbook/FEHB15.asp#31.
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  • Temporary Continuation of Coverage (TCC) is available to: (1) employees who lose their FEHB Program coverage because they leave their Federal jobs, (2) children who lose their FEHB Program family member status because they reach age 26, and (3) former spouses who lose their FEHB Program family member status because of divorce or annulment. TCC allows former employees to continue their FEHB Program coverage for up to 18 months, and former family members (children and former spouses) to continue FEHB Program coverage for up to 36 months. For more information about TCC, please review the TCC pamphlet at www.opm.gov/insure/health/eligibility/tcc/index.asp.
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  • 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.
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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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  • 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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  • 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 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 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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  • No.  FEHB law does not permit any exclusions or waiting periods for pre-existing conditions in any plan in the FEHB Program.  This is also true if you change plans after you retire. 
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  • It depends.  If your daughter is your only eligible family member and she acquires TRICARE, you may change your FEHB enrollment to self only based on this qualifying life event.  But if you must maintain a self and family enrollment to cover other family members, you may not remove your daughter from your enrollment.  FEHB will coordinate benefits with TRICARE.
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      • A spouse, including a valid common law marriage.
      • Children under age 26 (including adopted children, recognized natural children or stepchildren (including children of same-sex domestic partners in certain states); or foster children living with tribal employee in regular parent-child relationship>
      • Children age 26 or older incapable of self-support, if disabling condition began before age 26
    Which family members are not eligible?   
      • Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
      • Parents
      • Siblings
      • In-laws
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  • Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren (including children of same-sex domestic partners in certain states), and recognized natural (born out of wedlock) children.  Foster children are included if they live with you in a regular parent-child relationship. A 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. Your employing office will look at the child’s relationship to you as the enrollee to determine whether the child is a covered family member. 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.
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  • Yes. On June 26, 2013, the Supreme Court ruled that Section 3 of DOMA is unconstitutional. As a result of this decision, the United States Office of Personnel Management is now able to extend benefits to legally married same-sex spouses of Federal employees and annuitants.
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  • The effective date for the new FEHB Self Plus One enrollment type will be January 1, 2016. Therefore, the annual Open Season beginning on November 9, 2015 will include the new Self Plus One enrollment type in the enrollment choices available.
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  • The Self Plus One enrollment type will cover the enrollee and one eligible family member.
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  • Section 706 of the Bipartisan Budget Act of 2013 which amends Section 8905 of title 5, United States Code, to add a Self Plus One enrollment type to the FEHB Program.
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  • An eligible individual may choose one of the following enrollment options:
    1. Self Only, which covers only the enrolled employee or annuitant; or
    2. Self and Family, which covers the enrolled employee or annuitant and all eligible family members
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  • Yes, retirees/annuitants are eligible to participate in a FEDVIP dental plan, a FEDVIP vision plan, or both. Retirees must have retired with an immediate annuity (a FERS Minimum Retirement Age plus 10 annuity, postponed, counts as an immediate annuity). Those in receipt of a deferred annuity are not eligible to enroll in FEDVIP. Retirees can cover their eligible family members with a Self Plus One or Self and Family enrollment. More information is available on types of enrollments and eligible family members
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  • The effective date for the new FEHB Self Plus One enrollment type will be January 1, 2016.  Therefore, the annual Open Season beginning on November 9, 2015 will include the new Self Plus One enrollment type in the enrollment choices available.
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Total Count: 31, Number of Pages: 2, Page: 1
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