fehb family eligibility & child incapable of self support...parent-child relationship •a...

Brigette FitzgeraldHuman Resources Specialist

FEHBFamily Eligibility & Child Incapable of Self

Support

Achieving Excellence Through Knowledge

FEHBFamily Eligibility & Child Incapable of Self Support

Objectives

(2)

1 Review of Public Law 111-148, ACA

Review Extension of Insurance Coverage

Explain Dependent Eligibility Requirements

2

3

4 Explain Parental Responsibilities

5Review Foster Children & Child Incapable of Self Support Requirements

6 Questions & Answers


Public Law 111-148

• Enacted on March 23, 2010 by President Obama

• The Patient Protection and Affordable Care Act– PL 111-148

• The Health Care and Education Reconciliation Act of 2010 – PL 111-152

• Collectively, the Affordable Care Act (ACA) - also known as health care reform.

• Individual shared responsibility provision:

(3)

Maintain minimum health coverage for each month; or

Qualify for an exemption; or

Make a payment when filing his or her Federal income tax return


Public Law 111-148

The Health Insurance Marketplace

(4)

The Health Insurance Marketplace does not affect the FEHB Program

FEHB plans meet the requirements of the ACA

The Marketplace applies to does that do not qualify for FEHB coverage

There is NO government contributions to the premiums for Marketplace plans


Extension of Insurance Coverage

ACA extends family health

insurance coverage to

children until age 26.

(5)

Under Self Plus One or Self & Family

Dependent Children

Married Children

Children under 26 who previously lost coverage

Children who do not live with enrollee

Children not dependent on enrollee

Children covered under own insurance

Children who are not students


Dependent Eligibility

Married children can be covered

No residency requirements

No dependency

requirements

Children do not have to be students

or have prior coverage

(6)

Under ACA



(7)

Children Between ages 22 and 26

Covered under their parent’s Self and Family enrollment up to age 26 – even if

under 22

Married Children Covered until age 26 – excludes theirspouses and children

Children with or eligible for

employer-coverage

Covered up to age 26 even if eligible under own employer-provided

health insurance



(8)

Stepchildren Covered up to age 26 - do not have to live with enrollee

Children Incapable of Self-Support

Eligible for continued coverage past the age of 26 if the mental or physical disability began before age

26

Foster Children Coverage up to age 26



(9)

Foster Children

The child must live with the enrollee;

The parent-child relationship must be with enrollee, not solely the child’s biological parent;

Enrollee must be the primary source of financial support for the child;

Enrollee must expect to raise the child to adulthood; AND

Enrollee must sign a certification stating the foster child meets all the requirements.

Covered until age 26 only if the following five requirements are met:


Certification for Foster Children

(10)



(11)

A child whose parents have died and is now living with an enrollee

A child who is living with an enrollee grandparent

A child living with an enrollee under a pre-adoption agreement

A child who is in the legal custody of an enrollee


Parental Responsibilities

Parent-Child Relationship

• A "regular Parent-Child Relationship" means that an enrollee is exercising parental authority, responsibility, and control over the child by caring for, supporting, disciplining, and guiding the child, including making decisions about the child's education and health care.

(12)



(13)

Children of Same-Sex Domestic Partners

Effective June 26, 2013 – DOMA is unconstitutional

Legally married same-sex spouses are eligible family members under a Self Plus one or Self & Family

Children of same-sex spouses were covered as stepchildren – if partners lived in a state that did not recognize same-sex marriage

A Declaration of Domestic Partnership was required



(14)

Domestic Partnership is a committed relationship between two adults, of the same sex, in

which partners:

Intent to remain partners indefinitely;Maintain a common residence indefinitely;Are at least 18 years of age;Share responsibility of financial obligations;Are not married to anyone else;Are not a domestic partner of anyone else;Are not related in a way


Child Incapable of Self-Support

(15)

A DEPENDENT CHILD MAY BE CONSIDERED INCAPABLE OF SELF-SUPPORT IF:

The child’s physical or mental disability is expected to last at least 1 year

AND

Due to the disability, is not capable of working at a self-supporting job



A Dependent Child is incapable of Self-support when:

(16)

The child is as unemployable

The child is receiving:

• (a) benefits from Social Security;

• (b) survivor benefits from CSRS or FERS; or

• (c) benefits from OWCP;

Medical certificate documents that:

• (a) the child is confined to an institution due to a medical condition;

• (b) the child requires total custodial care; or

• (c) treatment has not and will not result in a self-supporting individual;

Medical certificate that describes a disability; or

Documentation states that there is a medical reason that restricts the child from working

A Dependent Child is incapable of Self-support when:



A disability such as blindness or deafness isn’t qualifying in itself

The onset before age 26 that doesn’t result in incapability until age 26 or after doesn’t qualify the child

Children incapable of self-support who had a QLE may continue under parent’s enrollment

If the child earns some income, it does not necessarily mean that they don’t qualify

(17)


TCC & Dependent Eligibility

18

Children eligible under Self Plus One or Self & Family

May cancel coverage if no longer needed under a QLE

May keep TCC coverage for their spouse and/or child

Eligible for 36 months of TCC on their 26th birthday


References

(19)

Public Law 111-148 – The Patient Protection and Affordable Care Act

Chapter 89 of Title 5 United States Code

FEHB Handbook

Benefit Administration Letter (BAL) 10-201




FEHBFamily Eligibility & Child Incapable of Self Support

(20)

Questions?

fehb family eligibility & child incapable of self support...parent-child relationship •a...

Documents