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What does "Health Care Reform" mean?
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, also known as health care reform.
One of the provisions of health care reform extends family health insurance coverage to children until age 26.
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Foster children are covered until age 26 if the following five requirements are met:
A child who lost coverage under parent’s FEHB enrollment:
Children under age 26 can be covered under the retiree’s Self Plus One or Self and Family enrollment.
A retiree who has a Self Only enrollment can change to a Self Plus One or a Self and Family enrollment during Open Season.
If you have a Self Plus One or Self and Family enrollment:
If you have a Self Only enrollment:
Employees who are not currently enrolled in the FEHB Program must enroll for Self Plus One or Self and Family.
Qualifying Life Event (QLE)
Beginning 1/1/11, currently eligible OTC products that are medicines or drugs will not be eligible for reimbursement unless enrollee has a prescription.
Insulin is exception.
Other currently eligible OTC items that are not medicines or drugs will not require a prescription in 2011.
Beginning 1/1/11, employee enrolled in FSAFEDS may request reimbursement for eligible expenses incurred by a
Prior to 1/1/11, eligible children limited to those who could be claimed as a dependent on Federal tax return.
ACA has extended the age of a child who may incur eligible expenses.
Expenses of employee’s child are covered through the taxable year prior to the taxable year in which the child turns 27.
Example: enrollees can not be reimbursed for expenses incurred by child who turns 27 anytime in 2011.
The ACA makes no changes to the:
ACA does not extend coverage to age 26 or provide coverage for married children under these Programs
Changes to Federal Benefits Eligibility Due to Health Reform Frequently Asked Questions (FAQs) Health Reform Frequently Asked Questions (FAQs)
Health Care Reform Extends Federal Employee Health Benefits (FEHB) To Children Until Age 26 Health Care Reform Extends Federal Employee Health Benefits
For information about the Affordable Care Act: Changes to Federal Benefits Eligibility Due to Health Reform and Open Season Changes
For information about the Affordable Care Act and Your Federal Benefits.
Legislation introduced in Congress to allow earlier implement of FEHB coverage for children to age 26 failed to pass in the Senate. The effective date of coverage to age 26 continues to be January 1, 2011.
The U.S. Office of Personnel Management has been preparing to implement the Affordable Care Act since the day it was signed into law. We want Federal employees, retirees, and their families to enjoy the benefits of this landmark legislation as soon as possible, and we are working on this with our partners in the White House, Congress, U.S. Department of Health and Human Services, and other agencies every day.
Under the Affordable Care Act, adult children up to age 26 will be eligible for health insurance coverage at the start of the next benefit plan year. The effective date of this provision is the first day of the plan year that is six months following enactment of the law. For the Federal Employees Health Benefits (FEHB) Program, that means January 1, 2011. Though we are eager to provide coverage to young adults prior to January 1, the current law governing the FEHB Program specifically prohibits us from doing so. Chapter 89 of title 5, United States Code, says unmarried dependent children are covered until age 22. Until the new law goes into effect, we must follow existing law.
We are working diligently with the Congress to address this matter and Congress has introduced legislation to address this issue.
In the meantime, children turning 22 are automatically covered for an additional 31 days under the parent's coverage policy. During this time, families can decide to continue FEHB coverage for their adult child for up to 36 months through the Temporary Continuation of Coverage (TCC) program. Under TCC, adult children can continue their coverage by enrolling as an individual in any FEHB plan. Though there is no Federal contribution toward the premium, the coverage policy is not subject to underwriting or pre-existing condition exclusions. Information about TCC is available in Insurance FAQs.
On March 23, 2010, President Obama signed into law the "Patient Protection and Affordable Care Act," Public Law 111-148. While some aspects of this law will not take effect until 2014, there are several major provisions that become effective before that time.
Among those is the coverage of a dependent until age 26. The effective date of this provision is the first day of the plan year that is six months following enactment of the law. For the Federal Employees Health Benefits (FEHB) Program, that means January 1, 2011.
The Office of Personnel Management (OPM) will take the necessary actions to comply with the new law by this effective date. We will provide additional information in the near future about the changes to FEHB plans for the 2011 plan year occurring as a result of passage of the PPACA so that employees and retirees have the information in time for the Open Season, which begins in November.