OPM Launches Health Insurance Review to Remove Ineligible Family Members
Federal employees who cover family members under their government health plans will soon face a new eligibility verification process.
According to a final rule published in the Federal Register, the Office of Personnel Management (OPM) plans to require documentation verifying that enrolled family members remain eligible for coverage under the Federal Employees Health Benefits Program (FEHB) and the Postal Service Health Benefits Program (PSHB).
Such documentation includes marriage certificates, tax returns, birth certificates, and foster or adoption paperwork. It applies to both Open Season and qualifying event enrollments, such as birth, adoption, or marriage.
Covered family members include a spouse, children under the age of 26, and in certain cases a disabled child over the age of 26.
OPM notes that uncovered family members include a grandchild (unless they qualify as a foster child), a former spouse, and a domestic partner.
OPM estimates it has four million family members enrolled in FEHB and PSHB in 2025– and that about three percent of those are ineligible.
Verification and Upcoming Audit
The rule — set to take effect in July– comes from the FEHB Protection Act which was part of the One Big Beautiful Bill Act passed last summer. The FEHB Protection Act requires OPM to create an eligibility verification process and a method for removing currently enrolled ineligible members.
The legislation came after the Government Accountability Office (GAO) reported in 2022 that the federal government may be spending more than $1 billion a year to cover people who don’t qualify for FEHB.
In addition to expanding the eligibility verification process, OPM said it is preparing an audit of currently enrolled family members.
Family members found ineligible could be removed from coverage, potentially resulting in higher costs for employees who fail to update their enrollments.
