Understanding Fehb Eligibility for Federal Employees

As a federal employee, you're likely eligible for the Federal Employees Health Benefits (FEHB) program, but what does that mean exactly? You're considered a federal employee if you work for the US government, including the military, postal service, and other agencies.

To be eligible for FEHB, you must be a federal employee in a position covered by the program. This includes employees in the civil service, as well as some military personnel and postal workers.

If you were hired by the District of Columbia Government in a benefits-eligible position before October 1, 1987, and paid into the plan for five consecutive years immediately before your retirement, you're eligible to participate in the Federal Employees Health Benefits (FEHB) program. This program is sponsored by the Office of Personnel Management (OPM).

Most federal employees are eligible to enroll in the FEHB program. Annuitants may also be eligible to continue their FEHB coverage into retirement if they meet certain requirements.

You can enroll in the FEHB program during your first 60 days as a newly eligible employee. You can also enroll during the Federal Benefits Open Season, which typically takes place in mid-November to mid-December. Additionally, you can enroll when you have a qualifying life event, such as marriage, divorce, or birth.

Here are the different enrollment periods:

Note that annuitants not currently enrolled in FEHB cannot enroll after retirement.

To be eligible for FEHB, you must be an active employee or annuitant of the federal government or a family member of one.

You can enroll in FEHB during the annual Federal Benefits Open Season, which usually takes place in November.

Family members include spouses, children, and other dependents, as long as they meet certain requirements.

As an employee, you can enroll in FEHB within 60 days of your appointment or promotion.

Family coverage is an important aspect of your benefits. Your spouse is automatically eligible for coverage under a Self and Family or Self Plus 1 enrollment.

To be considered a family member, your child must be under age 26. This includes adopted children, recognized natural children, and stepchildren.

You can also cover foster children if they meet certain requirements. They must be under age 26, currently living with you, and the parent-child relationship must be with you, not their biological parent.

You're the primary source of financial support, and you expect to raise the child to adulthood. If your child has a disability that began before age 26, they may still be eligible even if they're over 26.

Here's a quick rundown of eligible family members:

To learn more about your options, take advantage of the comprehensive plan comparison tool offered by OPM. This tool helps you explore your choices and make an informed decision.

Before making a final enrollment decision, review the individual FEHB brochures, as each one serves as the official statement of benefits for that plan.

If this caught your attention, see: Fehb Brochure

You'll need to submit proof of your family member's eligibility if you're enrolled in Self Plus One or Self & Family coverage.

OPM requires an Annual Review of Family Member Eligibility to ensure the integrity of the FEHB Program.

If you're randomly selected, you'll be asked to provide documentation to verify your dependents' eligibility.

You may be wondering what happens if you refuse to send the documentation.

If you don't provide the required documentation, your family members will be deemed ineligible and removed from coverage.

A different take: Fehb and Medicare Part B

To ensure you stay on top of your FEHB eligibility, it's essential to submit proof of eligibility within 60 calendar days of the open enrollment closing date.

You must submit acceptable proof of eligibility for each family member, or they will be removed from coverage.