One billion dollars is a BIG number. It also happens to be the amount the OPM may be spending per year on ineligible FEHB enrollees, according to a 2022 Government Accountability Office report. In order to help eliminate this problem, the OPM is creating new safeguards.
History Of The FEHB Program
In 1959, an Act of Congress established the FEHB program, and coverage for federal employees began on July 1, 1960. It’s currently the world’s largest employer-sponsored health insurance program and covers over 8 million federal employees, retirees, former employees, and family members.
Eligibility
Generally, most all federal employees are eligible for FEHB coverage, unless in a position excluded by law or regulation. You may even qualify for benefits if you’re a part-time, intermittent, or seasonal employee expected to work 130 hours per month or more for at least 90 days. The OPM identifies family members eligible for coverage as:
- Spouse
- Children under age 26, including:
- Adopted child under age 26
- Stepchild under age 26
- Foster child under age 26
- Disabled child age 26 or older, who is incapable of self-support because of a physical or mental disability that existed before their 26th birthday
“It might surprise you to learn that, prior to 2021, the OPM didn’t require any documentation to verify eligibility status.”
Validating Participant Eligibility
Open Season this fall will bring tougher guidelines for agencies to validate enrollees in FEHB. The OPM will require each agency to validate a random sampling of 10% minimum of FEHB elections for both Self-Plus-One and Self-and-Family enrollees. Should the sample reveal any ineligible members, the agency must act to remove them.
Taking Additional Action
It might surprise you to know that, prior to 2021, the OPM didn’t require any documentation to verify eligibility status. However, starting in 2025, adding a family member to your policy during Open Season will require you to provide proper eligibility documentation. Furthermore, a bipartisan bill introduced in March 2024 would require the OPM to confirm the eligibility of all added participants, potentially saving taxpayers hundreds of millions per year. It would also mandate an audit of FEHB to identify and remove any invalid participants.
Streamlining The Process
OPM’s 2025 budget request includes proposed legislation to create a more efficient, centralized enrollment system. As the OPM states “Current FEHB eligibility determination and enrollment is highly decentralized and requires cooperation between nearly 100 employing offices responsible for determining eligibility and enrolling more than 8 million members.” The centralized platform would mirror the updated Postal Service Health Benefits program, slated to roll out in November.
