The Office of Personnel Management (OPM) is currently sending email notices to all federal employees and retirees concerning family members who are included in employees’/retirees’ Federal Employees Health Benefits (FEHB) program health insurance plans. Federal law prescribes which family members may be covered under an employee’s or a retiree’s FEHB program or Postal Service Health Benefits (PSHB) program health plan. It is important that employees and retirees review the eligibility information (presented below) and ensure that all currently enrolled family members are eligible to be covered. If an employee or a retiree enrolled in the FEHB program or PSHB program has family members who are no longer eligible to be covered, the employee or retiree must contact OPM within 60 days in order to remove these family members.
Each year, it is an employee’s or a retiree’s responsibility to verify that covered family members continue to be eligible. In most cases, ineligible family members will not be removed automatically. Not verifying the eligibility of covered family members leads to the risk of fraud and improper payments. Ultimately, this may result in higher premiums for the group.
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Family members who may be included in the FEHB/PSHB program health insurance
- Current spouse. If an employee or a retiree is in a valid marriage or common law marriage, then the employee’s/retiree’s spouse is eligible for FEHB/PSHB coverage. A common law marriage must be initiated in a state that recognizes common law marriages for the marriage to be considered valid.
- Children under the age of 26. Children under the age of 26 are eligible for FEHB/PSHB coverage if they are: (1) Biological children; (2) Legally adopted children; (3) Stepchildren; or (4) Foster children for whom the employee/retiree is the primary source of financial support and where the employee/retiree has a parent-child relationship.
Note:
- In the case of a stepchild, the stepchild’s birth certificate must list the employee’s/retiree’s spouse as the parent. The employee/retiree must also verify their spouse’s eligibility even if the spouse is enrolled in the FEHB/PSHB program as part of the employee’s/retiree’s enrollment. In most cases, a stepchild loses coverage after the divorce or annulment from, or death of, the stepchild’s parent.
- A married child is eligible to be covered under the employee’s/retiree’s health plan but the child’s spouse and/or children are not eligible for FEHB/PSHB enrollment.
- Except as noted below, once a child becomes 26, they are no longer eligible as a family member and must be removed from the employee’s/retiree’s FEHB/PSHB enrollment.
- An employee’s/retiree’s adult child who is incapable of self-support. An employee’s/retiree’s disabled child, who is over the age of 26 and who is incapable of financially supporting themselves because of a physical or mental disability, is eligible for FEHB/PSHB coverage if: (1) Their physical or mental disability existed before age 26; and (2) Their disability is expected to continue for at least a year.
Family members not eligible for FEHB/PSHB coverage
The following family members are not eligible for FEHB/PSHB health insurance coverage:
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- An employee’s/retiree’s former spouse once their divorce is finalized.
- An employee’s/retiree’s children upon reaching age 26, unless a child is determined to be incapable of self-support.
- An employee’s/retiree’s parents.
- Grandchildren are not eligible unless they meet the requirements to be considered a foster child as determined by OPM, and
- Domestic partners.
What to do if a family member is no longer eligible for FEHB/PSHB coverage
An employee/retiree must notify OPM within 60 days of a family member becoming ineligible for FEHB/PSHB health insurance coverage. Once notified, OPM will then inform the family member to enroll in FEHB/PSHB program for themselves under Temporary Continuation of Coverage (TCC).
More details and information about how to verify a family member’s eligibility can be found in the Family Members section of the FEHB/PSHB Handbook which can be accessed at https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/family-members/.
FEHB family member eligibility documents
The following table lists documents that may establish family member eligibility for FEHB/PSHB health insurance coverage.
| Family Member | Acceptable Document(s) to Verify Eligibility |
|---|---|
| Spouse | Married less than 12 months: copy of government-issued marriage certificate. |
| Married 12 months or more: copy of government-issued marriage certificate and one of the following sets of documents listing spouse: | |
| Front page of most recent tax year’s federal or state tax return, or | |
| Proof of common residency (e.g., utility bill, other household bill, auto registration); | |
| and proof of financial interdependency (e.g., shared bank statement, credit card statement, life, or auto insurance policy). | |
| Child under age 26 | A copy of any one of the following documents listing children and enrollee: |
| Government-issued birth certificate, or | |
| Certificate of live birth, or | |
| Front page of the most recent tax year’s federal or state tax return; or | |
| Consular Report of Birth Abroad, or | |
| Official paternity test, or | |
| Voluntary affidavit of paternity or similar document, or | |
| Court or administrative order (e.g., National Medical Support Notice). | |
| Adopted child under age 26 | A copy of any one of the following documents listing child and enrollee. |
| Final adoption certificate or decree, or | |
| Authorized letter from a placement agency for the purpose of adoption, or | |
| Front page of most recent tax year’s Federal or state tax return with child’s name, or | |
| Court or administrative order (e.g., National Medical Support Notice). | |
| Stepchild under age 26 | A copy of any one of the following documents: |
| Birth certificate, or final adoption certificate/decree, listing current spouse as parent, or | |
| Front page of most recent tax year’s Federal or state tax return with child’s name, or | |
| Court or administrative order (e.g., National Medical Support Notice). | |
| The enrollee must also verify a spouse’s eligibility (see above for required documents), even if not enrolling the spouse in an FEHB plan. | |
| Foster child under age 26 | All the following documents: |
| Certification of foster child status | |
| Government-issued birth certificate or other document verifying child’s date of birth | |
| Documentation of regular and substantial support for the child, such as: | |
| Evidence of eligibility as a dependent child for benefits under other state or Federal programs. | |
| Proof of inclusion of the child as a dependent on the enrollee’s front page of most recent tax year’s federal or state income tax returns. | |
| Canceled checks, money orders, or receipts for periodic payments from the enrollee for or on behalf of the child. | |
| Evidence of goods or services which show regular and substantial contributions of considerable value. | |
| Any other evidence which OPM, in guidance, deems to be sufficient proof of support. | |
| If applicable, include copy of court order naming employee or spouse as child’s legal guardian. | |
| Disabled child age 26 or older who is incapable of self-support. | Medical certificate stating the child is incapable of self-support because of a physical or mental disability that existed before he/she became age 26 and is expected to continue for more than one year. |
Additional resources
- OPM Family Member Eligibility Verification: OPM’s page on the verification process, including outreach materials for employees
- FEHB/PSHB Handbook, Family Members section: OPM’s official eligibility rules and documentation requirements
- OPM Benefits Administration Letter 23-203: the letter that established the annual Family Member Verification Notice, with the notice template
- Federal Register final rule on verification requirements for family member coverage: the rule, effective July 2, 2026, requiring proof of eligibility when a family member is added
- Certification of foster child status: the OPM form required to cover a foster child
Edward A. Zurndorfer is a Certified Financial Planner, Chartered Life Underwriter, Chartered Financial Consultant and IRS Enrolled Agent in Silver Spring, MD. Tax planning, Federal employee benefits, retirement and insurance consulting services offered through EZ Accounting and Financial Services, located at 833 Bromley Street Suite A, Silver Spring, MD 20902-3019 and telephone number 301-681-1652.
Edward A. Zurndorfer is a CERTIFIED FINANCIAL PLANNER®, Chartered Life Underwriter, Chartered Financial Consultant, Registered Health Underwriter and Enrolled Agent in Silver Spring, MD. Tax planning, Federal employee benefits, retirement and insurance consulting services offered through EZ Accounting and Financial Services, located at 833 Bromley Street Suite A, Silver Spring, MD 20902-3019