Changes to Your Federal Health Care Plan

Health care has been at the top of the legislative agenda for the White House and Congressional Democrats and, now that the legislation has passed, there will be changes to the federal employee health care program. Here are some of the changes you will see in January 2011.

There will be several changes to your health care program beginning in January. Here are some of the most significant changes as outlined by the Office of Personnel Management (OPM). After the 2011 insurance premium figures become available, we will provide information on the new rates in a separate article.

Health Savings Accounts

Beginning January 1, 2011, currently eligible over-the-counter products that are medicines or drugs will not be eligible for reimbursement from your Health Savings Account (HSA) or your Health Reimbursement Arrangement (HRA). The exception will be if you have a prescription for that medicine or drug written by your physician.

The only exception is insulin. You will not need a prescription after January 1, 2011. Other currently eligible OTC items that are not medicines or drugs will not require a prescription.

Effective January 1, 2011, the 10% penalty for non-eligible medical expenses paid from an HSA will increase to 20%.

Coverage of Adult Children of Federal Employees

Earlier this year, a number of readers asked about having their adult children covered by the their federal employee health insurance. Some were hopeful that this new benefit would be in place in 2010 and, for awhile, it appeared that change would occur in 2010. That is less likely as the year goes on. (See Your Adult Children and Federal Employee Health Insurance)

But, as of January 1, 2011, the Federal Employees Health Benefits Program (FEHB) will be extended to include coverage for adult children of federal workers. Currently, only unmarried dependent children younger than 22 are eligible for health insurance coverage. The health care changes will expand coverage to adult children up to age 26. 

Children do not have to live with their parent, be financially dependent upon their parent or be students to be covered up to age 26. There is also no requirement that the child have prior or current insurance coverage. FEHB Program plans will send notice to all  enrollees of the coverage eligibility changes as a part of that plan’s Open Season communications according to OPM.

In cases where a child has employer-provided health insurance and is also covered under their parent’s Self and Family enrollment, the child’s employer-provided health insurance will be the primary payer. 

How to Add a Child to Your FEHB Plan

Here are instructions from OPM on how to have your children covered under your federal employee health plan.

  • If you currently have a Self and Family enrollment and you do not change to another health plan or option during Open Season, contact your FEHB plan and give them information on your newly eligible child.
  • Do not complete an SF 2809, Health Benefits Election Form, or enter dependent information in your agency’s self-service enrollment system to add your child to an existing Self and Family enrollment. Your child’s will be covered on January 1, 2011.
  • If you currently have a Self Only enrollment and you have newly eligible children, you must change your enrollment from Self Only to Self and Family if you want your children to be covered. You must use an SF 2809 or an agency self-service enrollment system to make this change.
  • If you are not currently enrolled and you want FEHB coverage since your children are now eligible, you must enroll for Self and Family coverage to provide coverage for your children. You must use an SF 2809 or an agency self-service enrollment system to make this change.

If you have  “Self Only” health insurance coverage and would like your newly eligible child to be covered by your policy, you must change to a Self and Family enrollment. If you do not change to a Self and Family enrollment as a “change in family status” or an Open Season change, your child will not be covered.

For more information, here is the OPM announcement of the change.

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