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An official website of the United States Government.

Special Initiatives Health Care Reform

 

Overview

Changes to Federal Benefits Eligibility Due to Health Reform: Frequently Asked Questions (FAQs)

Introduction

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.



Eligibility

My child is under age 26 and married. Is my child covered under my FEHB Self and Family enrollment?
Yes. Beginning January 1, 2011, your married or unmarried child under age 26 is covered under your Self and Family enrollment. However, your child's spouse and/or child are not covered.
I have grandchildren. Are they covered under my FEHB Self and Family enrollment?
No. A grandchild is not an eligible family member, unless the child qualifies as your foster child. For rules on foster children, see question 14.
My child lost FEHB coverage because he turned 22. Is he covered under my FEHB Self and Family enrollment?
Yes. Beginning January 1, 2011, your child is covered under your Self and Family enrollment up to his 26th birthday, even if he previously lost coverage because he turned 22.
My child does not live with me. Is he covered under my FEHB Self and Family enrollment?
Yes. Your child is not required to live with you to be covered under your Self and Family enrollment.
My child is not a dependent on my tax return. Is my child covered under my FEHB Self and Family enrollment?
Yes. There is no requirement that your child be a dependent for income tax purposes, nor does your child have to be financially dependent upon you, to be covered under your Self and Family enrollment.
My child is under age 26 but is not a student. Is my child covered under my FEHB Self and Family enrollment?
Yes. There is no requirement that your child be a student to be covered under your Self and Family enrollment.
My child is under age 26 and has been uninsured since turning 22. Is my child covered under my FEHB Self and Family enrollment?
Yes. Beginning January 1, 2011, your child will be covered under your Self and Family enrollment until his or her 26th birthday. There is no continuous insurance requirement.
My child has a pre-existing condition. Will my child be covered under my FEHB Self and Family enrollment?
Yes. The FEHB Program does not allow its participating health carriers to deny or delay medical benefits or coverage based on a pre-existing condition.
Is my stepchild covered under my FEHB Self and Family enrollment?
Yes. Beginning January 1, 2011, your stepchild is covered under your Self and Family enrollment until his or her 26th birthday. Your stepchild is not required to live with you or be financially dependent upon you.
Is my foster child covered under my FEHB Self and Family enrollment?
It depends. Beginning January 1, 2011, foster children, even if married, can be covered under their foster parent's Self and Family enrollment until their 26th birthday. To be considered a foster child for health benefits purposes, the following requirements must be met:
  • the child must live with you;
  • the parent-child relationship must be with you, not solely the child's biological parent;
  • you must be the primary source of financial support for the child; and
  • you must expect to raise the child to adulthood.
You must sign a certification stating that your foster child meets all the requirements. Contact your agency or Retirement System for more information.
Does health care reform extend Federal Employees Health Benefits (FEHB) coverage to children until they turn 26?
Yes. Previously, children of Federal enrollees lost health coverage when they turned 22 (plus a 31-day temporary extension of coverage). Beginning January 1, 2011, children of Federal enrollees will be covered by their 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 or she turned 22.
Does health care reform extend FEHB coverage to my married child?
Yes. Beginning January 1, 2011, your child under the age of 26, whether married or unmarried, is covered under your Self and Family enrollment. However, your child's spouse and/or child are not covered.
Can I get my child age 22 through 25 covered by FEHB sooner than January 1, 2011?
No. The current law governing the FEHB Program specifically prohibits us from providing coverage prior to January 1, 2011.

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Enrollment

I have an FEHB Self and Family enrollment. Do I need to do anything to get my child under age 26 back on my FEHB enrollment?
Yes; although your child is automatically covered under your Self and Family enrollment, you must notify your health plan to update their enrollment records. Your health plan will send you instructions before Open Season. Your health plan may ask for information such as your child's name, date of birth, and Social Security Number. If you do not receive these instructions by November 15th, contact your plan at the customer service number on your ID card.Do not complete an SF 2809 or use an agency self-service system to add your newly eligible child.
I get paid biweekly. I have a Self Only enrollment, or I am not currently enrolled in an FEHB plan. How do I get my child under age 26 covered effective January 1, 2011?
Use a Standard Form (SF) 2809 or an agency self-service enrollment system to change your enrollment to, or to enroll in, Self and Family.
Indicate that you have a "change in family status" Qualifying Life Event (QLE). Most employees should use QLE code '1C.'You can make the change or enroll between December 1, 2010 and March 2, 2011. Your child will be covered beginning January 1, 2011. If you enroll or make the change after January 1, 2011, your child will be covered retroactively to January 1 and you will pay premiums retroactively to the effective date of the enrollment or change.

Be aware that if you enroll or change your enrollment as an Open Season change, for most employees, it will take effect on January 2, 2011.

Contact your agency for more information.
I get paid monthly. I have a Self Only enrollment, or I am not currently enrolled in an FEHB plan. How do I get my child under age 26 covered effective January 1, 2011?
Use a Standard Form (SF) 2809 or an agency self-service enrollment system to change your enrollment to, or to enroll in, Self and Family during Open Season. Your Open Season change or enrollment will be effective January 1, 2011.

Be aware that retirees who are not currently enrolled in FEHB cannot enroll in FEHB, even if they have a newly eligible child. Retirees must have met certain eligibility requirements to continue their health benefits into retirement. However, if you are retired and you suspended your enrollment, you may reenroll in the FEHB program at Open Season. Contact your agency or Retirement System for more information.
I receive benefits from the Office of Workers' Compensation (OWCP) and have a Self Only enrollment. How do I get my child under age 26 covered effective January 1, 2011?
Use a Standard Form (SF) 2809 to change your enrollment to Self and Family.

Indicate that you have a "change in family status" Qualifying Life Event (QLE). OWCP recipients should use QLE code '2B.' You can make the change between December 1, 2010 and March 2, 2011. Your child will be covered beginning January 1, 2011. If you enroll or make the change after January 1, 2011, your child will be covered retroactively to January 1 and you will pay premiums retroactively to the effective date of the change.

Be aware that if you change your enrollment as an Open Season change, for OWCP recipients, it will take effect on January 16, 2011.

Contact your OWCP District Office for more information.
My child will turn age 22 before January 1, 2011. How can I prevent a break in his health insurance coverage?
Under FEHB law, enrollees' children who turn 22 are automatically covered for an additional 31 days under their parent's enrollment. Your child will have 60 days from his 22nd birthday to: For more information on TCC, see the TCC category below.
My child will turn age 26 after January 1, 2011. What happens on his 26th birthday?
Your child will no longer be covered under your Self and Family enrollment on his 26th birthday. On his 26th birthday, your child will get a 31-day temporary extension of coverage. Under the FEHB Program, your child will have 60 days from his 26th birthday to: For more information on TCC, see the TCC category below.
My child lost coverage under my FEHB Self and Family enrollment when she turned 22. She will turn age 26 before January 1, 2011. Can she enroll in Temporary Continuation of Coverage (TCC)?
No. Children can only enroll in TCC within 60 days of losing their coverage under their parent's FEHB enrollment. Your child lost FEHB coverage over three years ago. Since your daughter will turn 26 before January 1, 2011, she will not be eligible for FEHB under your enrollment; therefore, she will not eligible for TCC.
For more information on TCC, see questions 26-27.
I already have a Self and Family enrollment. Will adding my child under age 26 increase my premiums?
No. A Self and Family premium does not change based on the number of family members on your enrollment. If you are already enrolled in Self and Family when your child under age 26 is added, covering your child will not increase your premium costs.
My state has a law requiring health plans to cover certain children until age 30. Does this mean I can get my child covered by FEHB until age 30?
No. The FEHB Program is a Federal program and preempts state law requirements.
Can I remove my child from my FEHB Self and Family enrollment?
No. Your child will remain covered until his or her 26th birthday
Who is responsible for the out-of-pocket health expenses of my child age 22 through 25?
It depends. Generally, the adult child is responsible for any out-of-pocket health expenses charged by the health care provider. You can work with your provider to determine who pays for the out-of-pocket expenses incurred by your adult child. We cannot guarantee that the provider will not seek payment from you if your adult child fails to pay.

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Temporary Continuation of Coverage (TCC)

My child under age 26 is currently enrolled in TCC. Will she be covered under my FEHB Self and Family enrollment effective January 1, 2011 and what will happen to her TCC enrollment?
Your child will be covered under your Self and Family enrollment beginning January 1, 2011. Please note that your child's TCC enrollment will not automatically end when she regains coverage under your Self and Family enrollment. To avoid paying for unnecessary TCC, she may cancel her enrollment on or after the date her coverage under your Self and Family enrollment begins (probably January 1, 2011). When she turns 26, she will become eligible for TCC again.
She may cancel her TCC enrollment by sending a signed request specifying her desired cancellation date to:

USDA, National Finance Center
DPRS Billing Unit
PO Box 61760
New Orleans, LA 70161-1760

If you have additional questions, contact the National Finance Center at 800-242-9630 or nfc.dprs@usda.gov.
My daughter under age 26 lost coverage under my Self and Family enrollment when she turned 22. She now has a TCC Self and Family enrollment to cover her husband and son. Can she keep her TCC enrollment?
Yes. However, your daughter will be covered under two enrollments: your enrollment and her TCC. Because no person is entitled to receive benefits under more than one enrollment, both you and your daughter must notify your respective insurance carriers of the names of the persons to be covered under each enrollment. Your daughter may not file claims nor receive benefits under both enrollments.

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Retirees

I am retired and have a FEHB Self and Family enrollment. Will my child under age 26 be covered under my FEHB enrollment?
Yes. Your child under age 26 will be covered under your Self and Family enrollment. The health care reform law applies to employees and retirees. You must notify your health plan to update their enrollment records. Your health plan will send you instructions before Open Season. Your health plan may ask for information such as your child's name, date of birth, and Social Security Number. If you do not receive these instructions by November 15th, contact your plan at the customer service number on your ID card.
I am retired and have a FEHB Self Only enrollment. Can I switch to a Self and Family enrollment to cover my child who is under age 26?
Yes. You can change your enrollment in FEHB during Open Season. Your Open Season change will be effective January 1, 2011. Use a Standard Form (SF) 2809 or an agency self-service enrollment system to change your enrollment to, or to enroll in, Self and Family during Open Season. Your Open Season change or enrollment will be effective January 1, 2011.

Be aware that retirees who are not currently enrolled in FEHB cannot enroll in FEHB, even if they have a newly eligible child. Retirees must have met certain eligibility requirements to continue their health benefits into retirement. However, if you are retired and you suspended your enrollment, you may reenroll in the FEHB program at Open Season. Contact your Retirement System for more information.
I am retired and not currently enrolled in the FEHB Program. If I have a child who will be eligible on January 1, 2011, can I enroll in the FEHB Program?
No. Retirees who are not currently enrolled in FEHB cannot enroll in FEHB, even if they have a child who will be newly eligible on January 1, 2011. Retirees must have met certain eligibility requirements to continue their health benefits into retirement. However, if you are retired and you suspended your enrollment, for example, to use TRICARE, you may reenroll in the FEHB program at Open Season.
I am a retiree in interim pay status. Will my child under age 26 be covered under my FEHB Self and Family enrollment?
It depends. When you retire, your agency makes an initial determination about whether you are eligible to continue your health benefits into retirement. When your retirement application is processed, OPM will make a final determination about whether you are eligible to continue your health benefits into retirement. As long as you are eligible to continue FEHB into retirement and you have a Self and Family enrollment under FEHB, your child is covered until his or her 26th birthday effective January 1, 2011.

However, if your agency's initial determination was that you are eligible, and OPM's final determination is that you are not eligible, then your FEHB coverage will be terminated retroactively to the date of your retirement. If your coverage is terminated, you will have the opportunity to enroll in Temporary Continuation of Coverage (TCC). If you enroll in TCC, you will not have a gap in coverage. If you enroll in TCC and have a Self and Family enrollment under FEHB, your child is covered until his or her 26th birthday effective January 1, 2011.

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Disabled Children Incapable of Self-Support

Does health care reform affect the FEHB eligibility of disabled children incapable of self-support?
Yes. Prior to health care reform, children over age 22 who are incapable of self-support due to a disability that began before age 22 were eligible for FEHB coverage. Beginning January 1, 2011, children over age 26 who are incapable of self-support due to a disability that began before age 26 are eligible for FEHB coverage.

Contact your agency or Retirement System for additional information.
My child became incapable of self-support due to a disability that began before age 26 and prior to January 1, 2011. Will my child be eligible to be covered under my Self and Family FEHB enrollment?
If your agency determines your child is incapable of self-support because of a mental or physical disability that occurred before age 26 (regardless of his current age), he or she is covered under your Self and Family enrollment beginning January 1, 2011. Your agency will determine if your child meets the criteria for being incapable of self-support.
Will my FEHB plan pay for services my child received before January 1, 2011?
No. The plan can only pay for services incurred while your child was covered as an eligible family member.

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Two Married Federal Employees

I am a Federal employee who has a Self Only enrollment. My spouse is a Federal employee who also has a Self Only enrollment. My spouse is changing her enrollment to Self and Family to cover our child under age 26. Can I keep my Self Only enrollment?
No. You cannot keep your Self Only enrollment if your spouse has a Self and Family enrollment.

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Children Who Have Other Insurance

My child who is under age 26 has non-FEHB health insurance through his employer or school. Will he be covered under my FEHB Self and Family enrollment?
Yes. Beginning January 1, 2011, even when your child under age 26 has health insurance through his employer or school, he is covered under your Self and Family enrollment.
Then which insurance plan will pay benefits for an illness or injury?
Generally, your child's employer/school health insurance will pay claims first as the primary insurer. To the extent that the primary insurer does not fully cover the illness or injury, the FEHB plan may make additional payments, depending on the extent of coverage under the FEHB plan's benefits structure. This is known as "coordination of benefits." Both plans must be contacted to let them know that he has other insurance coverage.
My child doesn't need coverage under my FEHB Self and Family enrollment. Will he be covered anyway?
Yes, effective January 1, 2011 a child under age 26 is covered under an existing Self and Family FEHB enrollment.

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Children Who Are Federal Employees

I'm a 25-year-old Federal employee and am enrolled in the FEHB Program. My father is a Federal employee with a Self and Family enrollment under FEHB. Will I be covered under his enrollment and what will happen to my enrollment?
With two exceptions explained below, if your father has a Self and Family enrollment, you will be covered under his enrollment. Because no person is entitled to receive benefits under more than one enrollment, you must cancel your enrollment using an SF 2809 during Open Season. Be sure your agency puts this reason for your cancellation in the 'remarks' section of the SF 2809. When you turn 26, this will be a Qualifying Life Event allowing you to re-enroll in the FEHB program.

The two exceptions that would allow you to keep your own enrollment are if:
  • you have your own family (spouse and/or children) that you choose to cover under your Self and Family enrollment; or
  • you live outside the coverage area of your parent's plan.
If one of the above exceptions applies and you choose to keep your own enrollment, then because no person is entitled to receive benefits under more than one enrollment, you must notify your respective insurance carriers of the names of the persons to be covered under each enrollment. You may not file claims nor receive benefits under both enrollments.
I am under age 26 and I will start working for the Federal government in 2011. My parent has a Self and Family enrollment through FEHB. Can I enroll in my own FEHB plan?
It depends. You can only enroll in your own FEHB plan if:
  • you have your own family (spouse and/or children); or
  • you live outside the coverage area of your parent's plan.
If you do not enroll in your own FEHB plan because you are covered under your parent's plan, be sure your agency puts this reason in the 'Remarks' section of the SF 2809 when you elect not to enroll. Turning age 26 will be a Qualifying Life Event allowing you to enroll in the FEHB program under your own enrollment.
I start working for the Federal government in 2011. My parent has family coverage through her private employer. Can I enroll in my own FEHB plan?
Yes. You can enroll in your own FEHB plan.

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Other Federal Benefits Programs

I have a flexible spending account under the Federal Flexible Spending Account Program (FSAFEDS). Will FSAFEDS cover the health care expenses of my child until age 26?
Yes. Beginning January 1, 2011, an employee enrolled in FSAFEDS may request reimbursement for eligible health care expenses incurred by a child through the end of the calendar year in which the child turns 26. Please note that this is a different date than the date FEHB eligibility terminates. (Beginning January 1, 2011, children of Federal enrollees will be covered by their parent's FEHB Self and Family enrollment until their 26th birthday (plus a 31-day temporary extension of coverage)).
Who is an eligible child under FSAFEDS?
Beginning January 1, 2011 the definition of a child includes any natural child, stepchild, adopted child, eligible foster child, or child placed with you for legal adoption, even if you cannot claim that child as a dependent on your federal tax return. (PLEASE NOTE: This is not the same definition of child eligibility used under FEHB.) For more information about child eligibility, see FSAFEDS Summary of Benefits.
I have dental and/or vision insurance through the Federal Employees Dental and Vision Insurance Program (FEDVIP). Is my child age 22 through 25 covered under my FEDVIP enrollment?
No. Health care reform does not affect eligibility for children under FEDVIP.
I have life insurance through the Federal Employees Group Life Insurance Program (FEGLI). I am enrolled in FEGLI Option C, providing coverage for my spouse and eligible dependent children. Is my child age 22 through 25 covered under FEGLI Option C?
No. Health care reform does not affect eligibility for children under FEGLI.
I have long-term care insurance through the Federal Long-Term Care Insurance Program (FLTCIP). Can my child age 22 through 25 apply for Long-Term Care Insurance?
Yes. Health care reform does not impact child eligibility under FLTCIP. All adult children (at least 18 years old, including adopted or stepchildren) of living employees or annuitants are eligible to apply.

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More Information

Where can I get more information about the Affordable Care Act and Federal Benefits?
You may visit the OPM website's Health Care Reform page.

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Presentation

Changes to the Federal Employees Health Benefits (FEHB) Program Eligibility Due to Health Reform

Changes in FEHB Program Dependent Eligibility

Beginning January 1, 2011

  • Children are covered under their parent’s FEHB health plan’s Self and Family enrollment until age 26.
  • The law provides that this provision is effective beginning the first plan year following 6 months after enactment – for FEHB that is January 1.
Children Covered Under a Self and Family Enrollment
QuestionAnswer
Is my child covered until her 26th birthday?
Yes
Is my married child covered until her 26th birthday?
Yes
Is the spouse of my married child covered until her 26th birthday?
No
Is my child who lost coverage because he turned 22 covered until his 26th birthday?
Yes
My daughter doesn’t live with me. Is she covered until her 26th birthday?
Yes
My daughter isn’t financially dependent on me? Is she covered until her 26th birthday?
Yes
My son is no longer a dependent on my tax return. Can he be covered until his 26th birthday?
Yes
My son has a pre-existing condition. Is he covered until his 26th birthday?
Yes
My son has his own private insurance. Can he be covered until his 26th birthday?
Yes
My daughter is not a student. Can she be covered until her 26th birthday?
Yes
Stepchildren Covered Under a Self and Family Enrollment
QuestionAnswer
Is my stepchild covered until his 26th birthday?
Yes
Does my stepchild have to live with me?
No
Does my stepchild have to be financially dependent on me?
No
Disabled Children Incapable of Self-Support Covered Under a Self and Family Enrollment
QuestionAnswer
If my child becomes incapable of self-support due to a disability that begins at age 24, will he remain on my enrollment after his 26th birthday?
Yes
Will my FEHB plan pay for services my 24 year old child received before January 1, 2011?
No

Foster Children Covered Under a Self and Family Enrollment

Foster children are covered until age 26 if the following five requirements are met:

  • The child must live with you;
  • The parent-child relationship must be with you, not solely the child’s biological parent;
  • You must be the primary source of financial support for the child;
  • You must expect to raise the child to adulthood; and
  • You must sign a certification stating your foster child meets all the requirements.

Temporary Continuation of Coverage (TCC)

A former employee or former spouse:

  • May add children under age 26 (even if married) back on a Self and Family enrollment.
    • For Self Only enrollments, TCC enrollees may change to Self and Family during Open Season through the National Finance Center (NFC).
  • If not changing plans, enrollee or child contacts the health plan with enrollment information.
  • If the child has a spouse and/or children, the spouse and/or children are not eligible.

A child who lost coverage under parent’s FEHB enrollment:

  • Is eligible again under parent’s Self and Family enrollment.
  • May cancel TCC if no longer needed.
    • Child may keep their TCC to cover their own spouse and/or child
  • Is again eligible for 36 months of TCC on his 26th birthday.

Retirees

Children under age 26 can be covered under the retiree’s Self and Family enrollment.

A retiree who has a Self Only enrollment can change to a Self and Family enrollment during Open Season.

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How to Get Your Newly Eligible Children Covered in the FEHB Program

Self and Family Enrollments

If you have a Self and Family enrollment:

  • If you do not change to another health plan or option during Open Season, your newly eligible child(ren) will automatically be covered on January 1, 2011.
  • You should contact your FEHB plan to provide information on the newly eligible child(ren).
    • Your FEHB plan will send you a letter with instructions.
  • You DO NOT complete an SF 2809 or use an agency self-service enrollment system to add a child to an existing Self and Family enrollment.

Self Only Enrollments

If you have a Self Only enrollment:

  • You must change enrollment to Self and Family to cover your newly eligible children.

Not Enrolled in FEHB

Employees who are not currently enrolled in the FEHB Program must enroll for Self and Family.

Effective Dates

Qualifying Life Event (QLE)

  • A QLE change may be made from 31 days before to 60 days after the event causing the change in family status (January 1)
  • The change will take effect on the first day of the pay period that includes January 1.

Open Season

  • The first day of the first pay period that begins on or after January 1, 2011.
  • For most Federal employees this will be January 2, 2011.
  • For retirees this will be January 1, 2011.

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Changes to the Federal Flexible Spending Account Program (FSAFEDS) Eligibility Due to Health Reform

Coverage of OTC Medicines or Drugs

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.

Expanded Coverage for Child’s Eligible Expenses

Beginning 1/1/11, employee enrolled in FSAFEDS may request reimbursement for eligible expenses incurred by a

  • Natural child
  • Stepchild
  • Adopted child
  • Eligible foster child or
  • A child placed with employee for legal adoption

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.

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Other Benefit Programs Not Affected by Health Reform

The ACA makes no changes to the:

  • Federal Employees Dental and Vision Insurance Program (FEDVIP)
  • Federal Employees’ Group Life Insurance Program (FEGLI) or the
  • Federal Long Term Care insurance Program (FLTCIP)

ACA does not extend coverage to age 26 or provide coverage for married children under these Programs

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Updates

Posted: November 23, 2010

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

Posted: November 17, 2010

For information about the Affordable Care Act: Changes to Federal Benefits Eligibility Due to Health Reform and Open Season Changes

Posted: September 28, 2010

For information about the Affordable Care Act and Your Federal Benefits.

Posted: May 12, 2010

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.

Posted: April 23, 2010    UPDATED: May 12, 2010

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.

Posted: April 2, 2010

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.

Control Panel