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OPM is proposing new standards to improve enrollment integrity and accuracy in Federal employee benefits programs, including the Federal Employees Health Benefits (FEHB) and Federal Employee Group Life Insurance Programs. This would include amendments to 5 CFR parts 870 and 890 to establish a new eligibility determination process for children who are age 26 and over and who are incapable of self-support (ISS). In addition, OPM will (1) allow employing offices to adjust enrollment type from Self and Family or Self plus one to Self Only if there is only one person covered by the enrollment and (2) prohibit ineligible family members from receiving a 31-day extension of coverage when their coverage is terminated due to a reduction in the enrollee’s enrollment type.

Statement of Need:

This rule improves program integrity and saves money for the Federal Government by (1) updating an outdated process for certifying FEHB eligibility for adult children who are incapable of self-support; and (2) allowing agencies to appropriately match the FEHB enrollment type to the individuals enrolled.

Anticipated Costs and Benefits:

While OPM and other agencies would likely incur additional costs to effectuate this regulation, OPM estimates the new ISS determination process would produce cost savings for the FEHB Program. OPM has determined that reducing enrollment type would not result in cost savings to the Federal Government; it may save enrollees costs in enrollee contribution.