Child benefits – Health benefits for disabled children

As I pointed out earlier, the law allows children to be covered by the federal employee health benefits program until the age of 26, even if they are married. At this point, their FEHB coverage usually ends. However, this age limit does not apply to a child who is unable to support himself and is single.

If you are an employee or retiree enrolled in an auto plus one or auto and family option of a FEHB plan, your child may continue to have health care coverage beyond the age of 26 if you provide proof. in support of such a request.

Acceptable evidence includes:
• certification by a state or federal rehabilitation agency that the child is unfit for work,
• the receipt of survivor benefits from the CSRS or the FERS as a disabled child,
• receipt of Social Security or OWCP benefits as a disabled child, or
• a medical certificate attesting that the child is unable to support himself

If you are an employee, you will need to provide this proof to your personnel office, which is responsible for determining whether the criteria are met. If this is the case, it will inform your FEHB plan. If you are retired, you will need to notify the OPM, who will make the decision and provide it to your plan.

Depending on the nature of your child’s disability, it may be necessary to periodically provide proof that the disabling condition still exists.

Your disabled child’s health benefit coverage will end if the child marries, recovers from disability, becomes able to support himself, or dies. However, benefits can usually be reinstated if the marriage ends, if the original disability returns, or if your child is no longer able to support himself.

To note: The term “unable to support themselves” generally means that the child earns less than the equivalent of GS-5, step 1. However, this is not a hard and fast rule. In making a decision, the OPM will take into account both the child’s income and their current condition or prognosis.

FEHB: Draining the swimming pool (Premium)

Child benefits – Health insurance

Child benefits – Life insurance and annuities

Take it or leave it: the choice before retirement eligibility

Federal benefits and retirement dates

FERS Retirement Guide 2021

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