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Family Member Eligibility For Federal Employees' Health Benefits Program Coverage

FSIS Notice 43-24
Issue Date Oct 11, 2024
Expiration Date Nov 01, 2025
Full Notice
FSIS Notice 43-24
  1. PURPOSE
    This notice provides all FSIS employees instructions regarding the Office of Personnel Management's (OPM's) annual requirement that Federal employees review and ensure that family members on their Federal Employees Health Benefits (FEHB) Program plan are eligible to be covered by the plan.
  2. BACKGROUND
    1. As required by the OPM Benefits Administration Letter (BAL) BAL 23-203 all FSIS employees are to annually review eligibility rules and verify that family members are eligible to be covered under their FEHB plan.
    2. Employees are responsible for verifying that covered family members are eligible and are to work with their Benefits Specialist or the employee's FEHB Carrier to remove any family members who become ineligible. In most cases, ineligible family members will not be removed automatically. Not verifying the eligibility of covered family members leads to the risk of fraud and improper payments, which may result in higher premiums for all Federal employees under plan coverage. As a reminder, any intentionally false statement or willful misrepresentation, such as including an ineligible family member(s) on the employee's health insurance coverage, is a violation of the law punishable by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both (18 USC 1001), and may be subject to investigation.
  3. EMPLOYEE RESPONSIBILITIES
    1. Employees are to review the following eligibility information in Section IV (also available in the Family Members section of the FEHB Handbook) and ensure that all of the employee's family members are eligible to be covered.
    2. If employees have questions regarding a family member's eligibility, they are to contact their Benefits Specialist by sending an email to Ask.Benefits@USDA.gov with the subject line, "FEHB Family Member Verification."
    3. If employees have family members they need to remove from their FEHB Program plan, they are to contact their Benefits Specialist by sending an email to Ask.Benefits@USDA.gov, with the subject line, "FEHB Family Member Verification," within 60 days of a family member becoming ineligible. A Benefits Specialist will inform the family member of their option to enroll in FEHB for themselves under Temporary Continuation of Coverage, or as a Former Spouse. In addition, employees may also have an opportunity to change their plan or enrollment type. The benefits office may request documentation of eligibility at any time, and documentation is required when employees make a change to their FEHB enrollment.
  4. FAMILY MEMBER COVERAGE ELIGIBILITY
    1. The following family members can be covered by an employee's FEHB Program plan:
    2. Current Spouse: If the employee is in a valid marriage or common-law marriage, then the employee's spouse is eligible for FEHB coverage. A common-law marriage must be initiated in a state that recognizes common-law marriages for the marriage to be considered valid. Documentation requirements for common law marriages include a court order or judgment recognizing the marriage, the employee's declaration, tax returns, or other proof of common residency. See Appendix 1 of FEHB Family Member Eligibility Documents.
    3. Children under age 26 are eligible for FEHB coverage if they are the employee's:
      1. Biological children;
      2. Legally adopted children;
      3. Stepchildren; In the case of a stepchild, the birth certificate is to list the employee's current spouse as a parent, and the employee is to also verify the spouse's eligibility even if the employee's spouse is not enrolled. In most cases, a stepchild loses coverage after divorce, annulment, or the parent's death;
      4. Foster children for whom the employee is the primary source of financial support and with whom the employees have a parent-child relationship. Employees cannot add a foster child without approval from an FSIS Benefits Specialist; and
      5. Married children under the age of 26 are eligible to be covered under the employee's FEHB plan, but their spouse and children are not eligible to be covered under the employee's plan.
      NOTE: Disabled adult children at or above the age of 26 who are incapable of financially supporting themselves because of a physical or mental disability are eligible for FEHB coverage if their physical or mental disability existed before the age of 26 and their disability is expected to continue for at least 1 year.
    4. The following family members cannot be covered by an employee's FEHB Program plan:
      1. A former spouse once a divorce is finalized. By law, an employee cannot cover a former spouse under the employee's enrollment in a FEHB Program Plan, even if there is a court order requiring the employee to provide health insurance;
      2. Children upon their 26th birthday (unless determined to be incapable of self-support);
      3. Parents;
      4. Grandchildren (unless they meet the requirements to be considered a foster child as determined by an FSIS Benefits Specialist); and
      5. Domestic partners.
  5. QUESTIONS
    Refer questions regarding this notice to Ask.Benefits@USDA.gov with Subject Line, "FEHB Family Member Verification."