Types of Enrollment

Each FEHB plan has two types of enrollment: (1) self only and (2) self and family.

Self Only Enrollment

• This enrollment provides benefits only for you.

Self and Family Enrollment

• This enrollment provides benefits for you and your eligible family members.

Family Members Eligible for Coverage

• Your spouse.

• Your unmarried dependent children under age 22, including legally adopted children.

• Your unmarried dependent recognized children under age 22 born out of wedlock:

1. Who live with you in a regular parent-child relationship; or
2. For whom a judical determination of support has been obtained; or
3. To whose support you make regular and substantial contributions.

    

• Your unmarried dependent stepchildren under age 22 if they live with you in a regular parent-child relationship.

• Your unmarried dependent foster child (or children) under age 22 if:

1. The child (who may or may not be related to you) lives with you in a regular parent-child relationship; and
2. You are raising the child as your own, exercising full parental responsibility and control; and
3. You expect to continue to raise the child indefinitely into adulthood.

• A child is not a foster child for health benefits purposes if:

1. The child is temporarily living with you as a matter of convenience; or
2. A welfare or social service agency places the child in your home and retains control of the child; or
3. A natural parent of the child also lives with you and is able to exercise or share parental responsibility and control.

• Your unmarried dependent children age 22 or over who are incapable of self-support because of physical or mental incapacity that existed before their 22nd birthday; the incapacity must be expected to last at least one year from the date of medical certification of incapacity. (Ask your employing office about the medical certification required for a child age 22 or over. If the child is not yet 22, you should submit the medical certificate to your employing office at least 30 days before the child's 22nd birthday.)

All eligible family members are covered under a self and family enrollment; you can't decide to cover some and exclude others. However, other relatives -- for example, your parents or grandchildren (unless a foster parent-child relationship exists) -- are not eligible for coverage as family members even though they live with you and are dependent upon you.

Events Causing Family Members to Lose Eligibility for Coverage

If family member is..................................Event

1. Your wife or husband...............................Divorce or annulment of marriage.
2. A child under age 22.................................Marriage or attainment of age 22.
3. A disabled child age 22 or over.............. Marriage or recovery of ability for seff-support.

**Note: You will not be notified by your employing office when your child loses eligibility because of age, normally your plan will advise you of this event. If your child wants to temporarily continue group coverage, you must notify your employing office of the child's loss of eligibility for coverage as a family member within 60 days after his or her 22nd birthday; If he or she wants to convert to nongroup coverage, you or the child must apply to the carrier of your plan for a conversion contract within 31 days after his or her 22nd birthday.

• Family members lose eligiblity for coverage on the day that any of the above events occurs, subject to the 31-day extension of coverage for conversion to nongroup health benefits contract.

• You do not have to notify your employing office when, a family member loses eligibility for coverage if at least one other eligible family member remains covered by your self and family enrollment. However, if your spouse loses eligibility because of your divorce, you should promptly notify your plan in writing. (See also sections titled Enrollment of Former Spouses, Conversion Rights, and Temporary Continuation of Coverage.)

• If you become the only person oovered by your self and family enrollment, you may immediately change to a less expensive self only enrollment. To do this, obtain a Health Benefits Registration Form (Standard Form (SF) 2809) from your employing office, complete the form and return it to your employing office.

Coverage of New Family Members

Self Only Enrollment

You must change to a sell and family enrollment If you want to provide coverage for a new family member, eg., newborn child or a new spouse. To do this, find the event that permits the change in the section titled "Table of Permissible Changes" to determine when you can change. Then complete an SF 2809 and give it to your employing office within 60 days after a change in family status or anytime between 31 days before and 60 days after a change in marital status.

Self and Family Enrollment

A new family member is automatically covered under your self and family enrollment, but your plan may ask you for information to verify the family members eligibility when is claim for benefits is filed for that person.

**Note: Your employing office does not monitor changes in your marital or family status and will not automatically change your enrollment. If you need to change your enrollment from self only to self and family or vice versa, you must file an SF 2809 with your employing office. See the table on page 13 to find out when such changes may be made.