The Office of Personnel Management just released guidance clarifying the nitty-gritty of coverage for those seeking to take advantage of extended enrollment for dependents, which took effect on Jan. 1. OPM outlined the details surrounding enrollment changes, as well as issues pertaining to dual FEHB enrollments, foster children, kids with other (non-FEHB) health coverage and dependents incapable of self-support.
Self and Family: Federal employees who want to enroll newly eligible children in their health plan must be part of, or actively switch to, a Self and Family enrollment option. A Self Only enrollment will not automatically convert to Self and Family to cover newly eligible children, according to OPM. If the employee is subject to a court or administrative order requiring him or her to provide health benefits to dependents, the FEHB Children's Equity Act requires the employee be covered under Self and Family.
Dual FEHB enrollments: Federal employees under the age of 26 whose parents are federal workers or retirees are covered under their parents' FEHBP. These children cannot be enrolled in their own FEHBP unless they have their own spouse and/or children they want covered under their own plan, or they live outside the coverage area of their parents' health maintenance organization. This also applies to new federal employees under the age of 26 who are covered under their parents' FEHBP.
New federal employees: New feds under the age of 26 who have family insurance coverage through a private employer can enroll in FEHB.
Foster children: FEHB enrollees must provide documentation to add a foster child under the age of 26 to Self and Family coverage. The child must be under age 26 and must currently live with the enrollee, who must be the primary source of financial support for the child; the parent-child relationship must be with the enrollee and not the biological parents, and the enrollee must expect to raise the child into adulthood.
Children with other (non-FEHB) coverage: An enrollee cannot remove a child from Self and Family coverage even if the child has other health insurance coverage. The dependent's employer or school health insurance will pay claims first as the primary insurer, and the FEHBP might make additional payments depending on the extent of coverage. The enrollee must inform both plans that the child has other insurance coverage.
Children incapable of self-support: Married children who cannot take care of themselves because of a mental or physical disability that occurred before age 26 are now eligible for FEHB coverage. Prior to the law, the child had to be single and have a disability that occurred before age 22. Children older than 26 in this category, whose disability occurred between ages 22 and 26, are now eligible for FEHB coverage.To obtain such coverage in this instance, the employee must provide medical documentation that the disability occurred before age 26.