United States

Office of 

Personnel Management

The Federal Government’s Human Resources Agency

Benefits Administration Letter

Number: 13-208 Date: October 30, 2013

Subject: Federal Employees Dental and Vision Insurance Program (FEDVIP):

Continued Eligibility for Disabled Children Over Age 22

This is to remind you that it is the employing agency’s responsibility, under FEDVIP, to 

determine whether a dependent child age 22 or over is incapable of self-support because of a 

mental or physical disability that began before age 22. In addition, agencies must promptly 

notify BENEFEDS. BENEFEDS administers enrollment and premium payment processes on 

behalf of the FEDVIP carriers, and needs this information as quickly as possible to properly 

manage enrollments. 

Background 

As a result of the Affordable Care Act (ACA), effective January 1, 2011, children are covered 

under their parent’s Federal Employees Health Benefits (FEHB) Program Self and Family 

enrollment until age 26. However, under their parent's Federal Employees Dental & Vision 

Insurance Program (FEDVIP), children are only eligible for coverage until they reach age 22. 

FEDVIP enrollments may include a child incapable of self-support because of a physical or 

mental incapacity that existed before age 22. An enrollee’s employing office is responsible for 

making decisions about whether a family member is eligible for coverage. If BENEFEDS has 

any questions about whether someone is an eligible family member, it may ask the enrollee or 

the employing office for more information. BENEFEDS must accept the employing office's 

decision on the family member's eligibility.

Employing Office Determination

The employing office is responsible for determining whether a dependent child age 22 or over is 

incapable of self-support because of a mental or physical disability that began before age 22 and 

for notifying BENEFEDS of its determination. Determinations should be made within 60 days 

after the initial enrollment or the child’s 22nd birthday (or temporary incapable of self-support 

expiration date). The resulting determination (not the actual documentation) should be emailed

immediately to BENEFEDS at FEDVIPAdministration@ltcpartners.com. The agency should 

also include the name of the current FEDVIP enrollee. The dependent child is incapable of selfsupport when: 

he/she is certified by a state or federal rehabilitation agency as unemployable;

he/she is receiving: (a) benefits from Social Security as a disabled child; (b) survivor 

benefits from CSRS or FERS as a disabled child; or (c) benefits from OWCP as a 

disabled child; 
2 

a medical certificate documents that: (a) the child is confined to an institution because of 

impairment due to a medical condition; (b) the child requires total supervisory, physical 

assistance, or custodial care; or (c) treatment, rehabilitation, educational training or 

occupational accommodation has not and will not result in a self-supporting individual; 

a medical certificate describes a disability that appears on the list of medical conditions

(Attachment 1); or 

enrollee submits acceptable documentation that the medical condition is not compatible 

with employment, that there is a medical reason to restrict the child from working, or 

that he/she may suffer injury or harm by working. 

If the child earns some income, (generally no more than the equivalent of the GS 5, step 1), it 

does not necessarily mean that he/she is capable of self-support. The employing office will take 

both the child's earnings and condition or prognosis into consideration when determining 

whether he/she is incapable of self-support. 

Documentation of Incapacity for Self-Support 

To continue a child's eligibility for FEDVIP coverage once he/she reaches age 22, an enrollee 

must submit documentation to the employing office. This documentation can include the 

certification of unemployable status, the proof of Social Security benefits or a doctor's certificate 

about the child’s disability. The doctor must sign the certificate, and the certificate must show 

the doctor’s office address. 

The certificate must state the following: 

The child’s name 

That the child is incapable of self-support because of a physical or mental disability 

The type of disability 

That the disability started before the child reached age 22

If the disability is temporary or permanent; if temporary, a time period must be provided 

The agency should put the documentation and its determination in the employee’s Official 

Personnel Folder (or its equivalent). 

If an agency has on file a determination that was made for the Federal Employees’ Group Life 

Insurance (FEGLI) program, the same determination can be used for FEDVIP. The employee 

does not need to submit additional documentation. The agency should notify BENEFEDS of the 

previous determination by emailing FEDVIPAdministration@ltcpartners.com. 

If you have any questions about this information, please contact Connie deLorimier at (202) 606-

0164 

Sincerely, 

John O’Brien 

Director 

Health and Insurance