Your Adult Children and Federal Employee Health Insurance

Will your adult children be covered under your federal health insurance until they are 26 years old? It is a simple question but the answer is as complex as “yes”, “no”, and “maybe”.

The federal human resources program is often complex, confusing and sometimes contradictory. Here is a good example.

A few days ago, FedSmith published an article about health care and changes that are coming to the federal employee health care program.

We noted in the article that as more information became available, we would provide it for our readers but that we did not want to speculate on how the new legislation would be interpreted and applied by the Office of Personnel Management (OPM).

A number of readers asked if their adult children would be covered up to 26 years of age based on the new health care legislation. Rather than trying to respond to all of these queries individually, and since there is widespread interest in the subject, here is what we do know.

Will any of your adult children be covered until they are 26 based on the new health care legislation? The answer is more complex than a simple “yes” or “no”.

Here is information from OPM on this topic:

Under the Affordable Care Act, adult children up to age 26 will be eligible for health insurance coverage. The effective date of this provision is the first day of the plan year that is six months following enactment of the law. For the Federal Employees Health Benefits (FEHB) Program, that means January 1, 2011.

That statement seems clear that the effective date of this new benefit will be January 1, 2011. But it gets more complex.

Here is a statement from Blue Cross and Blue Shield, the company that offers popular health insurance programs for federal employees:

Healthcare reform legislation signed into law last month by President Obama would make coverage available to adult children up to age 26 for plan years beginning September 23, 2010. Recognizing that this timetable could result in many young people losing their coverage prior to this date because of their age, student status, including graduation from school, or other factors, every Blue Cross and Blue Shield company has agreed to allow covered individuals under age 26 to remain on their parents’ individual health insurance policies effective June 1.

So which is correct? Will you be able to have coverage for adult children up to age 26 beginning on September 23, 2010 or on January 1, 2011? Here is more information from OPM:

Though we are eager to provide coverage to young adults prior to January 1, the current law governing the FEHB Program specifically prohibits us from doing so.

So, from all of this, the answer appears to be that coverage will not begin until January of 2011.

But that definitive statement still doesn’t answer the question. OPM says that the matter is not yet resolved and that you may be able to get the coverage prior to January of 2011 and, in the meantime, there is a partial solution.

We are working diligently with the Congress to address this matter. In the meantime, children turning 22 are automatically covered for an additional 30 days under the parent’s coverage policy. During this time, families can decide to continue FEHB coverage for their adult child for up to 36 months through the Temporary Continuation of Coverage (TCC) program. Under TCC, adult children can continue their coverage by enrolling as an individual in any FEHB plan. Though there is no Federal contribution toward the premium, the coverage policy is not subject to underwriting or pre-existing condition exclusions.

For more information on Temporary Continuation of Coverage, you can go to the relevant portion of the OPM website. If this is of interest to you, be sure you act promptly. You have 60 days from your child’s 22nd birthday to notify your Human Resources Office your child turned 22. Your child has 60 days from the later of (1) the 22nd birthday or (2) the date of the TCC notice from the Human Resources Office to request enrollment for TCC.

In short, the current answer is that changes to the health care insurance for adult children will not become effective until January 2011. OPM is working to change the existing law to enable insurance companies to offer extended coverage at an earlier date.

If there is a change, and companies such as Blue Cross and Blue Shield are able to offer the coverage earlier, we will let our readers now quickly.

About the Author

Ralph Smith has several decades of experience working with federal human resources issues. He has written extensively on a full range of human resources topics in books and newsletters and is a co-founder of two companies and several newsletters on federal human resources. Follow Ralph on Twitter: @RalphSmith47