Insurance FAQs Health

Changes in Health Coverage

• Which family members are eligible for Federal Employees Health Benefits? View more
  • 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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• Which family members are NOT eligible for Federal Employees Health Benefits? View more
  • Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
  • Parents
  • Siblings
  • In-laws

    Which family members are eligible for Federal Employees Health Benefits?   

  • 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
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• What options do I have if I have lost FEHB coverage because I turned age 26? View more
  Upon turning age 26 and losing FEHB coverage, you may:

  • Enroll in TCC. Please see Temporary Continuation of Coverage for more information: http://www.opm.gov/healthcare-insurance/healthcare/temporary-continuation-of-coverage/
  • Purchase insurance on the Marketplace. Please visit Healthcare.gov  for more information: http://www.healthcare.gov
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• When I turn age 26, am I eligible for a 31-day extension of coverage? View more
  Yes. You will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.
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• Where can I get more information on age 26 and other health care reform initiatives that affect FEHB? View more
  For more information, please visit Health Care Reform. * Note: Under provisions of the Affordable Care Act effective January 2014, you must have minimum essential health coverage or you may have to make a payment when filing your Federal income tax return. For more information, please visit www.IRS.gov.
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• Where can I get more information on coverage for former spouses? View more
  For more information, please visit the Coverage for Former Spouses page. * Note: Under provisions of the ACA effective January 2014, you must have minimum essential health coverage or you may have to make a payment when filing your Federal income tax return. For more information, please visit www.IRS.gov.
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• Why am I ineligible for FEHB coverage? View more
  FEHB law dictates which Federal employees are eligible for FEHB coverage based on the type of appointment you have and your scheduled work hours. For more information, please visit the Eligibility Section of the FEHB Handbook.
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• What options do I have if I do not have (have lost) FEHB coverage? View more
  Upon separating from Federal employment and losing FEHB coverage, you have several options. You may:

  • Enroll in TCC. Please see Temporary Continuation of Coverage for more information.
  • Purchase insurance on the Marketplace. Please visit www.healthcare.gov for more information.

  * Note: Under provisions of the ACA effective January 2014, you must have minimum essential health coverage or you may have to make a payment when filing your Federal income tax return. For more information, please visit www.irs.gov.
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• How is a SHOP different than the individual Marketplace Exchanges? View more
  A SHOP is designed specifically for employer-sponsored health insurance coverage, whereas the individual Exchanges are designed for individual health coverage that is not tied to one’s employment.
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• As a former employee, am I eligible for a 31-day extension of coverage? View more
  Yes. Former employees will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.
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• As a former spouse, am I eligible for a 31-day extension of coverage? View more
  Yes. Former Spouse will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.
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• What options do I have if I do not have FEHB coverage? View more
  If you are ineligible for FEHB, you may purchase insurance on the Marketplace. Please visit www.Healthcare.gov for more information. * Note: Under provisions of the ACA effective January 2014, you must have insurance of some sort or will have to pay a tax penalty. For more information, please visit www.IRS.gov
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• What happens if I am a Member of Congress or designated congressional staff and my SHOP plan is no longer offered in the next coverage year? View more
  If your plan is no longer offered in the next coverage year, you must enroll in a different plan during the open enrollment to continue coverage. If you do not enroll in a different plan during open enrollment, you will lose SHOP coverage and your Government contribution.
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• As a Member of Congress or designated congressional staff, will I still be eligible for the Federal Employees Dental and Vision Program (FEDVIP)? View more
  Yes. For more information, please contact your employer’s benefits officer.
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• I am a part-time, designated congressional staff member. If I currently receive a Government contribution, will I continue to receive the same contribution toward the cost of my health insurance premiums purchased on the Marketplace? View more
  Yes. Your employer will use the same FEHB Program guidelines to determine your eligibility for a Government contribution.
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