Health Reform Changes for Federal Benefits Programs 

Effective January 1, 2011 

On March 23, 2010, President Obama signed the Affordable Care Act, (ACA), Public Law 111-148. 

Several provisions of the ACA will affect eligibility and benefits under the Federal Employees Health 

Benefits (FEHB) Program and the Federal Flexible Spending Account Program (FSAFEDS) beginning 

January 1, 2011. Please read the information below carefully. 

Federal Employees Health Benefits (FEHB) Program 

Please read the following section carefully as the actions you take will impact when your child’s 

FEHB coverage begins under this new law. 

What Are the Changes to FEHB Program Dependent Eligibility Rules Under the ACA? 

All changes are effective on January 1, 2011. 

Children Effect of ACA 

Between ages 22 and 26 Children between the ages of 22 and 26 are covered under their parent’s 

Self and Family enrollment up to age 26. 

Married Children Married children (but NOT their spouse or their own children) are covered 

up to age 26. This is true even if the child is currently under age 22.

Children with or eligible 

for employer-provided 

health insurance 

Children who are eligible for or have their own employer-provided health 

insurance are eligible for coverage up to age 26.

Stepchildren Stepchildren do not need to live with the enrollee in a parent–child 

relationship to be eligible for coverage up to age 26. 

Children Incapable of SelfSupport Children who are incapable of self-support because of a mental or physical 

disability that began before age 26 are eligible to continue coverage. 

Contact your human resources office or retirement system for additional 

information. 

Foster Children Foster children are eligible for coverage up to age 26. 

Children do not have to live with their parent, be financially dependent upon their parent or be students to 

be covered up to age 26. There is also no requirement that the child have prior or current insurance 

coverage. FEHB Program plans will send notice to all their enrollees of the coverage eligibility changes 

as a part of that plan’s Open Season communications.

In cases where children have employer-provided health insurance and are covered under their parent’s 

Self and Family enrollment, the children’s employer-provided health insurance will be the primary payer. 

FEHB will be the secondary payer. 
How Do I Add a Newly Eligible Child To My Enrollment?

What you must do: 

 If you currently have a Self and Family enrollment and you do not change to another health 

plan or option during Open Season, contact your FEHB plan and give them information on 

your newly eligible child. Do not complete an SF 2809, Health Benefits Election Form, or 

enter dependent information in your agency’s self-service enrollment system to add your 

child to an existing Self and Family enrollment. Your child will be covered on January 1, 

2011. 

 If you currently have a Self Only enrollment and you have newly eligible children, you must 

change your enrollment from Self Only to Self and Family if you want your children to be 

covered. You must use an SF 2809 or an agency self-service enrollment system to make this 

change. 

 If you are not currently enrolled and you want FEHB coverage since your children are now 

eligible, you must enroll for Self and Family coverage to provide coverage for your children. 

You must use an SF 2809 or an agency self-service enrollment system to make this 

change. 

Important: If you are enrolling or changing your enrollment, be sure to include all children up to age 26 

when completing your SF 2809 or using your agency’s self-service enrollment system. 

How can I enroll or change my enrollment so that my child is covered January 1st?

Be aware: The effective date of coverage for your newly eligible children depends upon the 

event used to enroll or change enrollment. 

If you are an employee who gets paid biweekly (this applies to most Federal employees) or you 

are an Office of Workers’ Compensation (OWCP) recipient, and you want you child covered on 

January 1, 2011, then you must enroll or change your enrollment as a “change in family status” – 

qualifying life event (QLE). The qualifying life event code to use on the SF 2809 is ‘1C’ for 

employees and ‘2B’ for OWCP recipients. 

You may change your enrollment from 31 days before to 60 days after January 1, 2011. Your 

change to Self and Family will take effect on the first day of the pay period that includes January 

1, 2011. Your child will be covered on January 1, 2011. If you make your QLE change after 

January 1st, your child will be covered retroactively to January 1, 2011 and you will pay 

retroactive premiums back to the effective date of the enrollment or change. 

If you enroll or change your enrollment as an Open Season change, it will take effect on the first 

day of the first pay period that begins in 2011. For most employees, this will be January 2, 2011.

For the Office of Workers’ Compensation, this will be January 16, 2011. For a few other 

agencies, the date may be different.

The table below shows the different date of coverage for most employees and OWCP recipients 

enrolling in FEHB or changing from a Self Only to a Self and Family enrollment as a “change in 

family status” – QLE change or as an Open Season change. 

Please visit www.opm.gov/insure for the most up-to-date information. 

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Effective Date of Coverage for Newly Eligible Children 

Enrollee Change in Family Status (QLE Change): Open Season Change: 

Most Employees January 1, 2011 January 2, 2011 

OWCP Recipients January 1, 2011 January 16, 2011 

For United States Postal Service employees, CSRS/FERS annuitants, Temporary Continuation of 

Coverage (TCC) enrollees and former spouses, an enrollment or change in enrollment made 

either as a “change in family status” QLE or as an Open Season change will provide coverage of 

eligible children on January 1, 2011. This is also true for other agencies and other retirement 

systems with a pay period that begins on January 1, 2011. 

If you have a Self Only enrollment and would like your newly eligible child to be covered, you 

must change to a Self and Family enrollment. If you do not change to a Self and Family 

enrollment as a “change in family status” QLE or an Open Season change then your child will not 

be covered. 

How Does This Affect Eligibility For Temporary Continuation of Coverage (TCC)? 

Children who lose coverage due to reaching age 26 are eligible for TCC for up to 36 months even if they

previously had TCC. 

If you are a child of an FEHB enrollee and you are now enrolled under Temporary Continuation of 

Coverage (TCC), you may no longer need your TCC enrollment since you will be covered under your 

parent’s Self and Family enrollment. Once you are assured of coverage under your parent’s Self and 

Family enrollment, you may want to cancel your TCC enrollment. To cancel your TCC, contact the 

National Finance Center at: 

USDA, National Finance Center 

DPRS Billing Unit 

PO Box 61760 

New Orleans, LA 70161-1760 

If you have additional questions, please contact the National Finance Center at 800-242-9630 or 

nfc.dprs@usda.gov. 

What is a Grandfathered Health Plan Under ACA? 

The Affordable Care Act requires that health plans include certain consumer protections and benefits 

coverage that affect some FEHB plan benefits for 2011. All plans in the FEHB Program have complied 

with all required provisions. However, certain protections and coverage terms depend upon whether the 

plan is considered a “grandfathered health plan” under the Act. 

A grandfathered health plan may preserve basic health coverage that was in effect when the law was 

enacted. If an FEHB plan indicates that it is a grandfathered plan that means certain benefit features 

including cost sharing, premium payments and covered services have not significantly changed from last 

year. 

While grandfathered health plans must comply with certain benefit requirements under the ACA, being a 

grandfathered plan also means that plan may not have included all benefit protections and coverage terms 

Please visit www.opm.gov/insure for the most up-to-date information. 

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that apply to other plans. Information on a plan’s specific benefit changes under the ACA will be 

available in the plan’s brochure. 

How Does the ACA Affect Benefits for High Deductible Health Plans? 

Beginning January 1, 2011, currently eligible over-the-counter (OTC) products that are medicines or 

drugs will not be eligible for reimbursement from your Health Savings Account (HSA) or your Health 

Reimbursement Arrangement (HRA) – unless – you have a prescription for that item written by your 

physician. The only exception is insulin - you will not need a prescription from January 1, 2011 forward. 

Other currently eligible OTC items that are not medicines or drugs will not require a prescription. 

Effective January 1, 2011, the 10% penalty for non-eligible medical expenses paid from an HSA will 

increase to 20%. 

Federal Flexible Spending Account Program (FSAFEDS) 

How Does the ACA Affect FSAFEDS? 

Coverage of Over-the-Counter Medicines or Drugs 

Beginning January 1, 2011, currently eligible over-the-counter (OTC) products that are medicines or 

drugs will not be eligible for reimbursement from your Health Care FSA – unless – you have a 

prescription for that item written by your physician. The only exception is insulin - you will not need a 

prescription. Other currently eligible OTC items that are not medicines or drugs will not require a 

prescription 

You will only be reimbursed for eligible OTC medicines and drugs purchased before January 1, 2011, and 

you must submit your claim on or before April 30, 2011. 

Expanded Coverage for Your Child’s Eligible Health Care Expenses 

Beginning January 1, 2011, an employee enrolled in FSAFEDS may request reimbursement for eligible 

health care expenses incurred by a natural child, stepchild, adopted child, eligible foster child, or a child 

who is placed with the employee for legal adoption. The child does not need to reside with the employee 

or qualify as the employee’s tax dependent. Prior to January 1, 2011, eligible children were limited to 

those who you could claim as dependent(s) on your Federal Tax return. 

The ACA has also extended the age of a child who may incur eligible expenses under an employee’s 

Health Care FSA. Expenses of an employee’s child are covered through the taxable year prior to the 

taxable year in which the child turns age 27. This means the child’s health care expenses are not eligible 

for reimbursement during the entire taxable year in which the child turns age 27. For example, enrollees 

cannot be reimbursed for expenses incurred by a child who turns 27 anytime in 2011. 

The ACA does not affect Dependent Care FSAs. 

Need more information? Call FSAFEDS at 1-877-372-3337/ TTY 1-800-952-0450. 

Other Federal Benefits Programs

Other Federal benefits programs are not affected by the Affordable Care Act for 2011. The Act has made 

no changes to the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal 

Employees’ Group Life Insurance Program (FEGLI) or the Federal Long Term Care Insurance Program 

(FLTCIP). Health care reform does not extend coverage for children until age 26 or provide coverage for 

married dependent children under these programs. 

Please visit www.opm.gov/insure for the most up-to-date information. 

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