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 FEHB ELIGIBLE FAMILY MEMBERS

Family members eligible for coverage under your self and family enrollment are your spouse (including a valid common law marriage) and children younger than age 26. Children include a child born within marriage, an adopted child, a stepchild, a foster child who lives with you in a regular parent-child relationship, or a recognized natural child. A child age 26 or older 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 cannot include a former spouse as a family member under your health insurance enrollment once you are divorced, even if the divorce decree specifies that you provide health insurance coverage for your former spouse. A former spouse can elect FEHB coverage under the provisions of Temporary Continuation of Coverage and/or the Spouse Equity Act.

You may be required by a court or administrative order to provide health benefits to your children. If you are subject to such an order, you must be enrolled in a self and family plan that provides full benefits to your children in the area where they live, or provide documentation that you have other health coverage for the children. If you are eligible for FEHB but do not have the appropriate coverage, the Civilian Benefits Center will notify you that it has received a court order requiring you to provide health benefits for your children.

To include a foster child as a family member, you must certify that:

  • The child is younger than age 26 (if the child is older than age 26, he or she must be incapable of self-support);
  • The child lives with you;
  • The parent-child relationship is with you, not solely the child's biological parent;
  • You are the primary source of financial support for the child; and
  • You expect to raise the child to adulthood.

To continue coverage for a child older than age 26 on your health insurance enrollment, you will be required to provide documentation that the child is incapable of working at a self-supporting job because of a physical or mental disability that existed before age 26 and is expected to continue for at least 1 year.

 ACTION REQUIRED TO INCLUDE A FOSTER CHILD

  1. Contact the Benefits Line for counseling.
  2. Complete CBC 12800-50, Foster Child Certification.
  3. Send the certification to the address on the form.

 ACTION REQUIRED TO INCLUDE A CHILD INCAPABLE OF SELF-SUPPORT

  1. Contact the Benefits Line for counseling.
  2. Ask your child's physician to complete 12890-6, Medical Certificate for Child Incapable of Self-Support documenting the disability, 60 days before your child turns age 26.
  3. Send the documentation to the address on the form.
  4. The Civilian Benefits Center will review the documentation, approve/disapprove the request, and notify the health insurance carrier whether the child is eligible to continue coverage.

 ACTION REQUIRED TO ADD OR DELETE A FAMILY MEMBER

  1. If you are currently enrolled in a self and family plan and want to retain the self and family enrollment, notify your health insurance carrier to add or delete a family member by completing 12890-08, Request to Add or Delete Members to a Current Family FEHB Enrollment and sending it to the carrier. You can send the form at any time, but the family member will not be able to receive services until the carrier has been notified.
  2. If you are currently enrolled in a self and family plan and have no eligible family members, you must make an election to a self-only enrollment using EBIS. The change is not automatic. If your health insurance premiums are withheld after taxes (you waived FEHB Premium Conversion), you can make the change at any time. If health insurance premiums are withheld before taxes (you participate in FEHB Premium Conversion), a child turning age 26 is a qualifying life event that would allow you to change your FEHB enrollment, but you must make the change within 60 days of the child turning age 26.
  3. If you are currently enrolled in a self-only plan, you can elect a self and family enrollment in conjunction with a qualifying life event or during the Benefits Open Season.
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