Child Coverage

Of all the questions swirling around health care reform, and there are many, we've heard from readers on one issue more than any other. When will federal employees be allowed to add their adult children under age 26 to their insurance plan? And what will happen to children who age out of medical coverage before the new rules kick in?

An e-mail from the Office of Personnel Management to federal human resources officers on March 26 outlined the timeline for adopting the new rules on coverage of adult children under the Federal Employees Health Benefits Program. The initial provisions of the Patient Protection and Affordable Care Act will begin to take effect in six months. Among them is the requirement that insurers allow adult children to stay on their parents' health care plan until they turn 26, instead of kicking them off when they turn 22.

When the requirement goes into effect, it will apply only to the new plan year. Federal employees can start adding their adult children to their coverage, or extending their enrollment, during this year's open season. But those changes won't kick in until Jan. 1, 2011.

Plan participants whose children lost their FEHBP coverage because they aged out of the program will be able to sign them up again during open season, if they are eligible under the new rules. And if their children are covered but are set to age out at the end of the plan year, then employees can do what they've always done -- renew their coverage.

One of the biggest concerns for readers is children who are covered through FEHBP, but will turn 22 before Jan. 1. That's understandable in this economic environment, where jobs are scarce and companies that are hiring might be taking on only part-time or contract workers for whom they do not have to provide benefits.

But an existing federal program could ease some parents' worries. Under the Temporary Continuation of Coverage provisions of FEHBP, children of plan participants can retain their health care coverage for up to 36 months after they turn 22.

To continue coverage under TCC, employees must notify their agency within 60 days after their child's 22nd birthday. Their agency then has 14 days to reach out to the child, who has an additional 60 days to select a health care plan and enroll as an individual member. Those time limits are strict: Only in rare circumstances will benefits offices accept late notifications or plan selections.

As an individual plan member, the child would get billed for the coverage. And it's more expensive to enroll in an individual plan than to continue covering someone under a family plan. But at least an option exists to give federal employees' children access to coverage. For children who will fall off their parents' insurance between now and Jan. 1, the higher cost of an individual plan would be temporary, until they can sign up again for family coverage.

Health care reform is a long and complicated process, one that really only began when the Patient Protection and Affordable Care Act became law. OPM will have to work out how to implement coverage for adult children and many other changes. Even if the new rules don't work perfectly for everyone or line up with critical birthdays, they do offer a four-year reprieve for many federal employees' children as they look for jobs and their own health care coverage.