Who is eligible for coverage under the Federal Employees Health Benefits program?

Almost all full-time federal employees are eligible as are many under various special categories, including part-time and temporary employees and intermittent employees in certain circumstances.

Also, effective with the 2015 plan year, employees on temporary appointments or on seasonal or intermittent schedules are eligible to enroll in FEHB if they are expected to work at 130 hours per month for at least 90 days (total, not annually). Note: The U.S. Postal Service has a separate health program for its non-career employees. See Chapter 3, Section 2 of the Federal Employees Almanac for details of these special rules.

Eligible family members for family coverage include an enrollee’s spouse—including in a common law marriage recognized in the state of residence or a same-sex spouse married in a jurisdiction (including in a foreign country) that recognizes such marriages, regardless of current residence. Also eligible are former spouses under certain conditions and children under age 26 (or any age if they are incapable of self-support because of a mental or physical disability that began before age 26), including legally adopted children, recognized children born out of wedlock, stepchildren and, in certain circumstances, foster children.

If the enrollee is in a same-sex domestic partnership meeting certain qualifications and living in a jurisdiction that does not recognize same-sex marriage, children of the partner are eligible as well; the partner himself or herself is not eligible, however.

An enrollee’s parents or other relatives are not eligible.

Detailed family eligibility rules are at www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/family-members/#geneligcov

Neither employees nor their family members are required to pass a physical examination to enroll for health benefits. Similarly, neither employees nor their family members can be excluded from joining an FEHB plan because of age or employment in a hazardous job.

2021 Digital Almanac

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