Child Turning Age 26 - The Effect on Health Insurance Coverage

When your child reaches age 26, he or she is no longer eligible to be covered under your health benefits enrollment, unless your child is incapable of self-support because of a mental or physical disability that existed before age 26. If your child turning age 26 means that you have no other eligible family members, or you have only one remaining eligible family member, you must submit a Health Benefits Election Form, SF 2809, to your Benefits Contact to change your enrollment to “Self Only” or “Self Plus One” coverage. The change is not automatic. Your child’s coverage terminates at midnight when he/she turns age 26, subject to a free 31-day extension of coverage.

To apply to continue your child’s coverage beyond age 26 due to a disability, you must provide a medical certificate from your child’s doctor. The certificate must indicate that the disability is expected to continue for at least 1 year, and your child is incapable of working a self-supporting job. Questions should be directed to your Benefits Contact./p>

For Temporary Continuation of Coverage (TCC) for your child, you have 60 days from the date your child turns age 26 to notify your Benefits Contact. Your Benefits Contact will give you information on how your child may enroll for coverage in their own right. The TCC enrollment can be for up to 36 months and your child will have to pay the full premium (Government share, employee share, plus a 2% administrative charge). TCC enrollments are also available to you (coverage for up to 18 months) should you leave the Government and for a former spouse should you get divorced (coverage for up to 36 months). All TCC enrollments must be submitted within 60 days of the event allowing the enrollment. You can view the TCC premiums at the OPM site.

If you have specific questions, please notify your Benefits Contact or AskBenefits@nih.gov.

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