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Insurance FAQs

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 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.
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  • If you are an annuitant or an employee who waived premium conversion, you can decrease enrollment at any time. If you are an employee who participates in premium conversion, 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 decrease your enrollment. You do not need to wait until the next Open Season to make this change; however, you need to request the change to decrease your enrollment within 60 days of your child turning 26
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  • 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.
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  • As long as you have a Self Plus One enrollment and your designated eligible family member is entitled to a survivor annuity or you have a Self and Family enrollment and one of the family members is entitled to a survivor annuity, the child(ren) 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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  •  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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  • 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.
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  • If the State in which you reside recognizes common-law marriages, yes.
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  • No, the children are entitled to receive benefits under only one enrollment.  Generally, when divorce occurs, one parent will enroll in Self Only coverage and the other parent will enroll in Self and Family coverage to provide benefits for the children.  If there is a reason for both parents to enroll in Self and Family coverage (i.e., both parents have remarried and need Self and Family enrollments to cover their new spouses and stepchildren), each enrollee must notify his or her insurance carrier of the name(s) of the child(ren) to be covered under his/her enrollment to prevent ant child from receiving dual coverage under FEHB (which is prohibited by Federal law). In cases where there are only two children, each parent could enroll in Self Plus One where they can each designate an eligible child.
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  • 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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  • Only you or a child born to or adopted by you and your former spouse (the Federal employee or annuitant) are covered under a Self Plus One 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. If you have more than one eligible child, only one child can be covered under a Self Plus One enrollment. 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.
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  • Your child can be covered under your Self Plus One enrollment  (if he or she is listed as your designated covered family member) or  your Self and Family enrollment until he/she turns age 26. There is no requirement that your child attend college to be covered under your Self and Family enrollment.
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Total Count: 31, Number of Pages: 2, Page: 2
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