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Hello everyone, I'm Ian Smith here with
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fedsmith.com. Can you believe it's
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almost fall already? It seems a little
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hard to believe the summer is just flown
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by, at least for me, probably a lot of
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you as well. And part of what that means
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is that open season is coming up. And
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that of course is the time where current
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and former federal employees who are
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under the Federal Employees Health
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Benefits Program or the Postal Service
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Health Benefits Program pick their uh
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benefits programs for the coming year.
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And OPM has made an important change
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uh regarding adding a spouse or a child
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to your FEHB coverage for
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uh open season for the coming year.
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That's the purpose of this video today.
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I want to go over the details of that.
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What's happened is the Office of
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Personnel Management or OPM has gone
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from spot checking a sample of family
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members being added to an FEHB program
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to checking every single one. So, if you
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miss the paperwork, then the family
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member doesn't get added. And so, in
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this video, I'll walk you through
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exactly what's changed, what
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documentation you're going to need, and
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who actually qualifies as a family
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member under FEHB. Let's take a look at
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the details. So, first, a little bit of
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history. It's important to note that
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this policy change did not come out of
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nowhere. Back in 2022, the Government
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Accountability Office looked into the
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FEHB program and found something OPM had
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not been tracking. Family members who no
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longer qualified for coverage or never
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did staying enrolled with no system in
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place to catch them. GAO estimated that
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a full audit could save somewhere
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between 360 million and a billion
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dollars. And Congress took notice of
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this, and OPM has been under pressure
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ever since to fix it. That pressure
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turned into law through the big budget
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reconciliation bill Congress passed in
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July 2025. That's Public Law 119-21.
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And tucked inside of it is a provision
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OPM refers to as the FEHB Protection Act
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It directed OPM to build a real
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verification process. And OPM's final
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rule took effect July 2nd of this year.
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Here's the core change.
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Before your employing office could ask
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for proof that a family member was
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but only really enforced it for certain
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life events like a marriage or a birth.
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Now it's not optional. Proof is required
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every time you add a family member and
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that includes open season which wasn't
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fully covered before. Here's the part
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that's actually new for this open season
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and it's something that most coverage
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hasn't caught yet. Since 2024, agencies
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were only required to check a minimum of
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10% of new family member additions. OPM
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just changed that though.
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which was issued on July 15th, agencies
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now have to verify 100% of open season
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elections where a family member is
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Now a question I'd expect a lot of you
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to have, what if you're not adding
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What if your spouse or your child has
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been on your plan for years and you're
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just renewing the same coverage?
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Based on OPM's own language, this 100%
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check is specifically tied to adding a
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family member. If you're not making a
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change, it suggests that you're not
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automatically pulled into this new
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review. That having been said, don't
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read that as a permanent pass because
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OPM and your employing office have
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always had separate authority to ask for
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proof of eligibility on anyone already
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enrolled at any time,
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open season or not. So this year's
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change is about new additions, but it's
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not the only way you could ever be asked
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to verify someone. Before we get to the
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paperwork though, it's worth being clear
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on who actually counts as a family
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member under FEHB statute.
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Your spouse qualifies. Your children
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under age 26 qualify whether they're
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biological, adopted, step, or foster
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And a disabled adult child can stay in
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your plan past age 26 as long as the
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physical or mental disability existed
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before the child turned age 26.
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On the other side, grandchildren,
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parents, domestic partners, and former
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spouses are not eligible, no matter how
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financially dependent they are on you.
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So, what actually counts as proof? For a
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spouse, that's a government-issued
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marriage certificate. For a child, a
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birth certificate or in the case of
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adoption, a final adoption decree.
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If you're keeping a disabled adult adult
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child on your plan past 26,
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you'll need medical certification
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confirming that the disability existed
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before that child turned age 26.
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But, this isn't the complete list,
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though. For every scenario, including
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stepchildren, foster children, the full
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documentation requirements are laid out
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in OPM's FEHB handbook, and I'll be sure
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to put links to that in the description.
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If your documentation doesn't hold up or
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you don't provide it at all, that family
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member won't be added to your coverage.
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If the family member was already added
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pending review, that coverage can be
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Your employing office has to notify you
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and you do have a window to push back.
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You can request reconsideration within
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60 days, but once that reconsideration
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decision has been made, it's final.
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There's no second round after that.
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Here's what I'd actually do before open
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If you know you're adding a spouse or a
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child this year, track down that
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marriage certificate or birth
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certificate now, not in the middle of
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the enrollment window. It's also worth
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taking a second look at who's currently
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on your plan. If you've got a former
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spouse or a child who's aged out and you
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haven't addressed it, this is a good
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time to do that on your own terms,
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rather than through a review.
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And if you're ever unsure whether a
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document you have is going to be
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accepted, your HR office can tell you
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before you're in the time crunch.
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And one thing to note, this video covers
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program information, not medical advice.
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So, if you have questions about a
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disability certification specifically,
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talk to your doctor or your benefits
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I've put links to the full documentation
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requirements along with some related
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articles on FedSmith in the description
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below. For more information on FEHB and
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open season, head over to fedsmith.com.
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We have a lot of articles on our site
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now, and we're also going to be adding
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more between now and the start of open
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So, keep an eye out for those. And also,
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while you're there, please sign up for
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our free email list. It lets you get our
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news updates delivered straight to your
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inbox. Thank you for watching, and I
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will see you next time.
