FEHB Program: Expanding Requirements for Verifying Eligible Family Members

On April 15, 2021, the Office of Personnel Management (OPM) issued Benefits Administration Letter (BAL) 21-202 regarding the documentation requirements for verifying family members who are eligible for coverage under the Federal Employees Health Benefits (FEHB) Program. 

The BAL provides guidance to Federal agencies on the following:

  1. The process for requesting proof of family member eligibility;
  2. What documents may be used as proof; and
  3. What employing office actions must be taken based on an employee’s response to a request for verification of eligibility.

A Federal agency must require proof of family member eligibility for coverage under the FEHB Program for:

  • new employees during their Initial Opportunity to Enroll (IOE); and
  • employees requesting FEHB changes due to a Qualifying Life Event (QLE).

When reviewing a new family member’s eligibility, Federal agencies may also verify the eligibility of family members currently enrolled who have not previously been verified.  Due to the large volume of transactions during the annual Federal Benefits Open Season, Federal agencies may, but are not required to, verify family member eligibility. 

Except for the Open Season, Federal agencies are responsible for processing all enrollment changes that affect premium withholdings (for example, change from Self Only to Self Plus One or Self and Family, etc.) by requiring a Health Benefits Election Form, SF 2809, from employees.  However, if the change does not affect the premium withholdings, employees are responsible for informing the health plans about certain changes to Self and Family enrollments.

If you have questions, refer them to your Benefits Contact or AskBenefits@nih.gov.

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