OPM Issues Regulations for Removal Process for Certain Individuals from FEHBP

United States Office of Personnel Management (OPM) logoYou may recall that in 2015, the Office of Personnel Management (OPM) sought to conduct a government-wide audit of Federal Employees Health Benefits Program (FEHBP) enrollees to verify the eligibility of family members enrolled in the FEHBP. However, at that time, OPM determined that it lacked certain authorities to require current employees to respond to their requests for information, and the planned audit was shelved. OPM has now issued regulations to provide for a process for the removal of individuals who are not eligible to be enrolled in FEHBP as family members.

Health insurance taxThe new regulations provide that an enrollee’s employing office (agency), or OPM, or the enrollee’s carrier (health insurance plan) may request verification of eligibility from the enrollee, at any time, of an individual who is covered as a family member. The request for documentation will indicate that, unless appropriate documentation is provided, the individual will no longer be covered by their FEHBP health plan 60 calendar days after the date of the notice. The regulations also provide a process for an enrollee to request removal of a family member from FEHBP, as well as a reconsideration process with retractive coverage. Once this rule is effective on February 22, 2018, OPM will be sending additional information to carriers and agencies with more detailed information including types of documentation and how these materials will be collected and shared between agencies and health plans.

Woman holding baby and a document in front of a computer while talking on the phone on her shoulder.There are approximately 4 million family members covered by FEHBP plans, and while OPM does not have an estimate of how many ineligible family members are currently enrolled, data from similar commercial health plans indicate that these health plans typically find 1–3 percent of spouses and 4–12 percent of children ineligible for coverage. This information is being provided for your awareness, should members begin to receive documentation requests for enrolled family members.