Post on 05-Jul-2020
Brigette FitzgeraldHuman Resources Specialist
FEHBFamily Eligibility & Child Incapable of Self
Support
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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
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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
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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
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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
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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
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Dependent Eligibility
(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
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Dependent Eligibility
(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
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Dependent Eligibility
(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:
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Dependent Eligibility
(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
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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)
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Dependent Eligibility
(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
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Dependent Eligibility
(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
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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
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Child Incapable of Self-Support
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:
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Child Incapable of Self-Support
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)
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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
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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
Benefit Administration Letter (BAL) 11-203
Benefit Administration Letter (BAL) 15-207