Employees
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General Information
Current DoDEA Vacancies
HR Advisor
May Human Resources Advisor Volume 2, Issue 5

Eligibility

As a Federal employee, you are entitled to enroll yourself and any eligible family member in a health plan offered under the FEHB Program, unless your position is excluded from coverage by law or regulation. Some of the more common exclusions include but are not limited to:

  • employees serving under an appointment limited to 1 year or less and who have not completed 1 year of current continuous employment;
  • employees who are expected to work less than 6 months in each year;
  • non-full-time employees without a prearranged regular tour of duty; and employees paid on a contract or fee basis

Election Required

If you are eligible to enroll in the FEHB Program, you must complete an election either to enroll in a plan or not to enroll. You must do this within 60 days after you become eligible. If you do not make an election, you are considered to have declined coverage.

Temporary employees are eligible to enroll only after completing one year of employment and beginning a second consecutive appointment; however, you do not receive any government contribution toward your premiums.

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage). This also includes legally married same-sex spouses, regardless of his or her state of residency. Children under age 26 are also eligible family members , including children of same-sex marriages, legally adopted children, stepchildren (to include stepchildren of a same-sex spouse), and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship.

To include a foster child as a family member, you must certify that:

  • The child is younger than age 26 (if the child is older than age 26, he or she must be incapable of self-support);
  • The child lives with you;
  • The parent-child relationship is with you, not solely the child's biological parent;
  • You are the primary source of financial support for the child; and
  • You expect to raise the child to adulthood.

A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. To continue coverage for a child older than age 26 on your health insurance enrollment, you will be required to provide documentation that the child is incapable of working at a self-supporting job because of a physical or mental disability that existed before age 26 and is expected to continue for at least 1 year.

In determining whether the child is a covered family member, your employing office will look at the child's relationship to you as the enrollee. Grandchildren are not eligible family members. However, your grandchild can qualify as a foster child if all the requirements are met.

Note: Parents and other relatives are not eligible family members, even if they live with and are dependent upon you.

Former Spouses/Court Orders

You cannot include a former spouse as a family member under your FEHB enrollment once you are divorced, even if the divorce decree specifies that you provide health insurance coverage for your former spouse. A former spouse can elect FEHB coverage under the provisions of Temporary Continuation of Coverage and/or the Spouse Equity Act.

You may be required by a court or administrative order to provide health benefits to your children. If you are subject to such an order, Public Law 106-394 requires mandatory Self and Family coverage if you are eligible for FEHB coverage and you do not comply with a court or administrative order to provide health benefits for your children. If this agency receives notification of such an order your will be contacted by the agency’s servicing Benefits Office that it has received a court order of this nature and you will be required to enroll in a Self and Family coverage plan that provides full benefits to your children in the area where they live or provide documentation that you have other health coverage for the children.

If you do not enroll in an appropriate health plan or provide documentation of other coverage for the children, DoDEA must enroll you for Self and Family coverage in the lower option of the Blue Cross and Blue Shield Service Benefit Plan (enrollment code 112).