Rule2026-11022
Federal Employees Health Benefits Program: Verification Requirements for Family Member Coverage
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Published
June 2, 2026
Effective
July 2, 2026
Issuing agencies
Personnel Management Office
Abstract
The FEHB Protection Act of 2025 (FPA) requires OPM to issue regulations and implement a process to verify: The veracity of any qualifying life event (QLE) through which a health benefits plan enrollee seeks to add a member of family to their enrollment and that when an enrollee adds a family member to the health benefits plan, including during any open season, the individual is a qualified member of family. This final rule also clarifies responsibilities for initial family member eligibility determinations for the Postal Service Health Benefits (PSHB) Program.
Full Text
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<title>Federal Register, Volume 91 Issue 105 (Tuesday, June 2, 2026)</title>
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[Federal Register Volume 91, Number 105 (Tuesday, June 2, 2026)]
[Rules and Regulations]
[Pages 32875-32880]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-11022]
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Rules and Regulations
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains regulatory documents
having general applicability and legal effect, most of which are keyed
to and codified in the Code of Federal Regulations, which is published
under 50 titles pursuant to 44 U.S.C. 1510.
The Code of Federal Regulations is sold by the Superintendent of Documents.
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Federal Register / Vol. 91, No. 105 / Tuesday, June 2, 2026 / Rules
and Regulations
[[Page 32875]]
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
[Docket ID: OPM-2026-0002]
RIN 3206-AP08
Federal Employees Health Benefits Program: Verification
Requirements for Family Member Coverage
AGENCY: Office of Personnel Management.
ACTION: Final rule.
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SUMMARY: The FEHB Protection Act of 2025 (FPA) requires OPM to issue
regulations and implement a process to verify: The veracity of any
qualifying life event (QLE) through which a health benefits plan
enrollee seeks to add a member of family to their enrollment and that
when an enrollee adds a family member to the health benefits plan,
including during any open season, the individual is a qualified member
of family. This final rule also clarifies responsibilities for initial
family member eligibility determinations for the Postal Service Health
Benefits (PSHB) Program.
DATES: Effective Date: This rule is effective on July 2, 2026.
FOR FURTHER INFORMATION CONTACT: Louise Dyer Yinug, Senior Benefits
Analyst, at (202) 972-0913. Sophia Iwanaga, Benefits Analyst, at (202)
936-2782.
SUPPLEMENTARY INFORMATION:
A. Executive Summary
The FPA (Sec. 90101, Public Law 119-21, 139 Stat. 362) directs OPM
to issue regulations and implement a process to verify: (1) that a
member of family is eligible to participate as a covered family member,
including during any open season; and (2) any QLE through which an
Federal Employees Health Benefits (FEHB) or PSHB plan enrollee seeks to
add a member of family to their enrollment, by July 4, 2026. These
regulations apply to both the FEHB and PSHB Programs. For clarity and
brevity, this rulemaking uses ``FEHB Program'' to include both the
Federal Employees Health Benefits Program and the Postal Service Health
Benefits Program. The PSHB Program launched in 2025 as a separate
Program within the FEHB Program and provides health benefits to Postal
Service employees, Postal Service annuitants, and their covered family
members.
In addition to the statutorily required elements, the rule is
clarifying that OPM can authorize the employing office to determine
family member eligibility for the PSHB Program.
B. Background
The FEHB Program was established in 1960 and is the largest
employer-sponsored health insurance program in the United States. There
are approximately 8.3 million covered individuals in the FEHB Program.
Covered individuals include employees of the federal government,
annuitants, covered family members, former spouses, and statutorily
eligible groups enumerated in 5 U.S.C. 8901; and tribal employees of
tribal employers, pursuant to 25 U.S.C. 1647b. Postal Service
employees, Postal Service annuitants, and their family members are
eligible for health benefits under the PSHB Program pursuant to 5
U.S.C. 8903c.
Covered Family Members
Per the FEHB statute at 5 U.S.C 8901(5), as adopted by reference in
the PSHB statute at 5 U.S.C. 8903c(a)(13), and FEHB and PSHB
regulations at 5 CFR 890.101, 890.302 and 5 CFR 890.1602, 890.1603,
890.1604 respectively, a covered family member means a member of the
family of an enrollee who meets applicable eligibility requirements.
This includes the enrollee's spouse and children under the age of 26.
Covered children include children born within marriage, recognized
natural children, adopted children, stepchildren, and foster children.
A disabled child age 26 or older who is determined by OPM to be
incapable of self-support because of a physical or mental disability
that existed before their 26th birthday can be a covered family member.
As delineated in the FEHB Handbook, a grandchild is not an eligible
family member unless the child qualifies as a foster child. (The FEHB
Handbook is available at <a href="https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/fehb-handbook">https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/fehb-handbook</a>.) Other examples of family
members who are not eligible for coverage under an employee or
annuitant's enrollment include an enrollee's parents, former spouse,
and domestic partner, even if they live with and are dependent upon the
enrollee. A covered family member can be added during the initial
opportunity to enroll, subsequent to a qualifying life event, such as
birth or adoption of a child or marriage, or during any open season.
Under certain circumstances outlined in 5 CFR part 890, subpart H
Benefits for Former Spouses, former spouses may have their own FEHB
enrollment, separate from the enrollment of the federal employee or
annuitant to whom they were married.
Previous OPM Action on This Topic
There are several ways that ineligible family members become
covered by FEHB plans. Some ineligible family members are added during
open season, and OPM has not required verification of eligibility by
the employing office. Some family members were once eligible as spouses
or covered children, but lost eligibility due to divorce, aging out, or
change in family status and were not removed from coverage.
OPM has addressed FEHB Program family member eligibility
verification and removal in earlier rulemaking. On January 23, 2018,
OPM issued a final rule titled, Federal Employees Health Benefits
Program: Removal of Eligible and Ineligible Individuals from Existing
Enrollments (83 FR 3059). The rule provided a process for removal of
certain individuals who are found not to be eligible as family members
for FEHB enrollment. The processes in the rule apply to individuals for
whom there is a failure to provide adequate documentation of
eligibility when requested. The rule also allowed certain eligible
family members to be removed from existing self and family or self plus
one enrollments upon request. If appropriate, the enrollee can change
from self and family or self plus one to a lower enrollment type. The
enrollment type can be changed either during open season or subsequent
to a QLE for enrollees paying for health benefits premiums on a pre-tax
basis (also called premium conversion). Enrollees not
[[Page 32876]]
participating in premium conversion can change enrollment type at any
time.
As explained in the 2023 interim final rule Postal Service Reform
Act: Establishment of the Postal Service Health Benefits Program (88 FR
20383) all requirements for the FEHB Program apply to the PSHB Program,
which began January 1, 2025, unless otherwise indicated through
rulemaking.
Subsequent to the 2018 rulemaking, OPM issued several guidance
documents for employing offices and carriers to further delineate
disenrollment and removal procedures for ineligible individuals.
Carrier Letter 2020-16 \1\ provided guidance to carriers on (1) the
process for requesting proof of family member eligibility for existing
enrollments; (2) the documents that may be used as proof; and (3) the
actions FEHB carriers can take based on an enrollee's or family
member's response to a request for verification of eligibility. Carrier
Letter 2022-15 \2\ provided guidance to FEHB carriers on proactively
removing covered children when they reach age 26, unless the child is
determined to be incapable of self-support due to a disability that
began before age 26. Benefits Administration Letter 20-203 \3\ provided
guidance to employing offices on (1) the process for requesting proof
of family member eligibility for existing enrollments; (2) the
documents that may be used as proof; and (3) the employing office
actions that can be taken based on an employee's or family member's
response to a request for verification of eligibility. (Carrier Letters
and Benefits Administration Letters are available at <a href="https://opm.gov/healthcare-insurance/carriers/fehb/">https://opm.gov/healthcare-insurance/carriers/fehb/</a> and <a href="https://www.opm.gov/healthcare-insurance/carriers/pshb/">https://www.opm.gov/healthcare-insurance/carriers/pshb/</a>.)
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\1\ <a href="https://www.opm.gov/healthcare-insurance/carriers/fehb/2020/2020-16.pdf">https://www.opm.gov/healthcare-insurance/carriers/fehb/2020/2020-16.pdf</a>.
\2\ <a href="https://www.opm.gov/media/dykpowdh/carrier-letter-2022-15-removing-ineligible-children-from-federal-employee-health-benefits-plan-fehb-program-coverage-508-compliant.pdf">https://www.opm.gov/media/dykpowdh/carrier-letter-2022-15-removing-ineligible-children-from-federal-employee-health-benefits-plan-fehb-program-coverage-508-compliant.pdf</a>.
\3\ <a href="https://www.opm.gov/retirement-center/publications-forms/benefits-administration-letters/2020/20-203.pdf">https://www.opm.gov/retirement-center/publications-forms/benefits-administration-letters/2020/20-203.pdf</a>.
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The FPA also requires that OPM develop a process to disenroll or
remove anyone from enrollment who is found to be ineligible for
enrollment or coverage. Pursuant to subsection (f) of the FPA, OPM has
reissued and reinforced guidance on disenrolling ineligible
individuals. in Carrier Letter 2025-15 and Benefits Administration
Letter 25-203.
Family Member Eligibility Verification Responsibilities
In addition to the regulatory requirements, the FEHB Handbook
details the responsibilities of the employing office to verify
eligibility of family members. For a newly added family member, the
employing office must obtain proof of a family member's eligibility in
two circumstances: during the initial opportunity to enroll and when an
enrollee has any other qualifying life event. For a QLE, the employing
office must require proof of family member eligibility for those that
have not previously provided proof including a:
<bullet> spouse not verified within the last year;
<bullet> foster child; and
<bullet> disabled child age 26 or older who is incapable of self-
support.
Acceptable documentation is listed in the FEHB Handbook and could
include government-issued marriage certificates, Federal or state tax
returns, or birth certificates. The employing office, OPM, or the
carrier may disenroll or remove an individual from an enrollment if the
enrollee fails to provide adequate documentation of the eligibility,
per 5 CFR 890.308 and 890.1608. An enrollee or removed individual may
request reconsideration of the decision to remove the individual from
enrollment from the employing office or OPM within 60 days of the
initial decision. That reconsideration is final.
C. Provisions of This Final Rule
This final rule builds on the 2018 rulemaking, which strengthened
verification and removal processes. This rule implements the FPA by
adding a new subparagraph (i) to Sec. 890.302(a)(1) to require, rather
than allow, enrollees to provide proof of eligibility to the employing
office, the carrier, or OPM, as specified by OPM, when adding a family
member to the enrollment. This proof will be required at any time that
an enrollee seeks to add a family member to their enrollment, including
during any open season, or for any QLE, including an initial
opportunity to enroll. This goes beyond the current requirement, which
allows employing offices, OPM, or the carrier to request proof at any
time, but only requires such proof for a QLE, including the initial
opportunity to enroll.
New subparagraph (ii) in Sec. 890.302(a)(1) requires the enrollee
to provide documentation verifying a QLE to an employing office, the
carrier, or OPM, as specified by OPM, to add a family member to the
enrollment. Once that information has been provided, OPM's existing
guidance will ensure that the event is verified, in addition to
verifying the eligibility of the added family member.
These new sections fulfill the statutory requirement for OPM to
implement a process for verification of family member eligibility.
Details of these processes, including responsibilities of the employing
office, will continue to be published in the FEHB Handbook and updated
as necessary.
Examples of acceptable eligibility documentation can be found in 5
CFR 890.308 and the FEHB Handbook and include:
<bullet> Government-issued marriage certificates
<bullet> Government-issued birth certificates
<bullet> Consular Report of Birth Abroad
<bullet> Paternity tests or other court-ordered documentation for
parental support
<bullet> Certification of foster child status
<bullet> Final adoption certificate or decree
<bullet> Federal tax returns for dependent children or step-children
under the age of 26
<bullet> Medical certification for adult disabled children incapable of
self-support
In addition to the statutorily required provisions, OPM is amending
Sec. 890.1607, which addresses the entity responsible for family
member eligibility verification for the PSHB Program. OPM's 2024 final
rule titled, Postal Service Health Benefits Program: Additional
Requirements and Clarifications (89 FR 85012) included Sec.
890.1607(b)(2). Prior to the launch of the PSHB Program, USPS was
responsible for family member eligibility verification for Postal
employees, as all employing offices are for FEHB enrollments. This
regulatory change is consistent with the Postal Service's past practice
under the FEHB Program and aligns with the responsibilities of other
employing offices.
D. Expected Impact of This Rulemaking
1. Statement of Need
OPM is required by section 90101 of Public Law 119-21 to issue this
regulatory action. The statutory provision directs that by July 4,
2026, the Director of OPM must ``issue regulations and implement a
process to verify'' (1) the veracity of any QLE through which an
enrollee in the Program seeks to add a member of the enrollee's family
to a health benefits plan under the Program; and (2) that, when an
enrollee seeks to add a member of his or her family to the health
benefits plan, the individual added is a
[[Page 32877]]
qualifying member of family with respect to the enrollee. The statute
requires this process to apply not only during a QLE but also during
any open season.
This regulation is necessary to address the presence of ineligible
family members covered by the FEHB Program. OPM addressed coverage of
ineligible family members through issuing regulations to provide a new
process for identifying and removing ineligible family members from
coverage in 2018. This final rule builds on and strengthens that 2018
rule.
Ineligible family member coverage was highlighted in a Government
Accountability Office (GAO) report (<a href="https://www.gao.gov/products/gao-23-105222">https://www.gao.gov/products/gao-23-105222</a>) in late 2022. In response to that report, OPM concurs that
there are ineligible family members participating in the Program and
more can be done to identify and remove them from coverage. That report
made several recommendations, many of which OPM concurred with and
implemented. While this work progresses, OPM is also preparing for the
family member eligibility audit required by the FPA. That audit is a
critical piece of addressing ineligible family member coverage and
restoring program integrity, but the economic effects of the audit are
not included in this rule since it is not affected by this rule.
2. Summary of Impacts
Since some FEHB and PSHB QLE and family member eligibility
verifications are required by current OPM guidance and rules, OPM
expects this regulation to have an impact below the threshold for
economic significance. However, given the importance of reducing waste,
fraud, and abuse through removing ineligible family members, this rule
is significant on policy grounds.
This final rule also includes a change specific to the PSHB
Program. This rule clarifies that responsibility may reside with OPM or
with the employing office as specified by OPM. This revision is not
expected to result in any significant impact as it is consistent with
the Postal Service's past practice under the FEHB Program and will
align with the responsibilities of other employing offices.
3. Regulatory Baseline
The baseline for this regulation is the FEHB and PSHB Programs as
currently administered. Since 2018, OPM has strengthened the
verification process, which historically has been largely delegated to
carriers and to employing offices. In 2025, OPM began requiring
agencies to conduct a self-audit of 10% of family member eligibility
for changes made during open season. Due to high transactions in open
season 2024 and staffing challenges in 2025, many agencies did not
reach the 10% threshold or did not report when OPM requested audit
information.
4. Costs
The FPA and this regulation mandate verification of the eligibility
of all family members and all QLEs for any enrollment, including any
open season. Agencies may see cost increases if additional employees
are required to conduct the statutorily mandated verification.
Congress authorized $66 million over ten years for OPM to carry out
the requirements of the FPA, including the family member eligibility
audit.
There is a time cost for enrollees and family members associated
with this rule. Assuming that it would take on average half an hour per
family member to gather and upload supporting documents such as
marriage and birth certificates, enrollees would spend about 50,000
hours annually complying with the requirements of the rule. A few more
complex cases may require additional documents and communication, e.g.,
to obtain updated proof for children incapable of self-support and
communicate it to employing offices, OPM, or carriers, but many others
will take less time.
This rule requires that all newly added family members are
verified. Member cost estimates assume an average hourly rate of $52
\4\ in end of year 2025 dollars adjusted with a nominal growth rate of
2% over the following decade. These do not explicitly include the costs
of obtaining certificates of birth, marriage, and other supporting
documents from authoritative sources. See Table 1.
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\4\ The average federal employee works 2,087 hours annually and
earned $106,870 in 2024 based on the latest available Sep 2024 data,
which translates into $51 average hourly rate in 2024.
Table 1--Net Present Value and Annualized Costs
----------------------------------------------------------------------------------------------------------------
3% Discount rate 7% Discount rate
---------------------------------------------------------------
Annualized Annualized
NPV (million amount NPV (million amount
$) (million $) $) (million $)
----------------------------------------------------------------------------------------------------------------
Agency Costs.................................... 20.9 2.4 17.3 2.5
Member Verification Costs....................... 20.9 2.4 17.3 2.5
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5. Transfers
Family members found ineligible will have to pay for alternative
coverage or go without coverage. Some individuals who are not enrolled
in FEHB coverage may be eligible for public insurance programs such as
Medicaid, the Children's Health Insurance Program (CHIP), or Medicare.
Some family members may be eligible to purchase coverage on the
Affordable Care Act (ACA) Exchanges with federal advance premium tax
credits that may cover all or a portion of an enrollee's premiums. That
coverage would transfer costs from the FEHB Program to other publicly
or privately funded health insurance coverage.
Premium Savings
The information reported by agencies to OPM so far indicates that,
of the more than 19,000 cases reviewed in 2024, almost 2% of FEHB and
PSHB family members have been confirmed to be ineligible, with up to
4.36% of family members that could be deemed ineligible due to non-
responses or insufficient documentation. More children (2.2%) than
spouses (1.66%) were confirmed to be ineligible or could end up being
deemed ineligible (4.67% vs 3.92%).
Because the information reported by agencies to OPM is a sample
with some degree of uncertainty that may not be entirely representative
of the underlying population, OPM considered estimates using somewhat
wider bounds ranging from 2% to 5% for ineligible children and 1.5% to
4.5% for spouses. The median projections of 3.5% ineligible
[[Page 32878]]
children and 3% ineligible spouses are in line with findings from
audits performed on state health insurance programs and in the private
market.
In 2025, there were approximately 4 million family members in FEHB
and PSHB, about 2.1 million children and 1.9 million spouses. OPM
assumes that approximately 100,000 family members would be verified
annually--63,000 children and 38,000 spouses. OPM estimates that the
annual premium cost for FEHB and PSHB family members with claims was
$5,510 for children and $12,461 for spouses with claims. The incentives
are stronger to fraudulently cover ineligible individuals when their
health care needs and costs are higher, but without other information,
savings estimates conservatively assume that the average premium cost
for ineligible family members with claims are the same as for eligible
family members.
Based on the assumptions above, OPM's central projection is that in
2025 total FEHB and PSHB premium rates would have been 0.018% lower
without those ineligible family members, with a low of 0.010% and a
high of 0.027%.
In Table 2, OPM applied these percentages to estimated annual
premiums calculated using a nominal medical inflation rate of 6.5% per
year, higher than the assumed 3.5% inflation for the next decade. Total
FEHB and PSHB premiums were approximately $72.7 billion in FY 2025.
Based on the parameters above, OPM estimated low, medium, and high
net present values (NPV) and annualized amounts of FEHB and PSHB
premium savings, and agency costs over the next decade, separately for
3% and 7% annual real discount rates. The results are summarized in
Table 2.
Table 2--Net Present Value and Annualized Premiums
----------------------------------------------------------------------------------------------------------------
3% Discount rate 7% Discount rate
---------------------------------------------------------------
Premium Savings Annualized Annualized
NPV (million Amount NPV (million Amount
$) (million $) $) (million $)
----------------------------------------------------------------------------------------------------------------
High............................................ 225.5 26.4 182.0 25.9
Medium.......................................... 153.7 18.0 124.1 17.7
Low............................................. 81.9 9.6 66.1 9.4
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6. Benefits
The benefits of this rule include more appropriate use of federal
dollars and a more sustainable FEHB Program. This rule will help direct
premium dollars to support eligible individuals only, thereby improving
the integrity of the program.
OPM estimates the net present value (NPV) of premium savings over
the next decade to be $153.7 million and $124.1 million at real
discount rates of 3% and 7% per year. The corresponding annualized
amounts are $18 million and $17.7 million, about 70 percent of which is
paid by the government. The NPV of agency verification costs over the
next decade are estimated at $20.9 million and $17.3 million for real
discount rates of 3% and 7% per year, with corresponding annualized
amounts of $2.4 million and $2.5 million. The NPV of member costs over
the next decade are estimated at $20.9 million and $17.3 million for
real discount rates of 3% and 7% per year, with corresponding
annualized amounts of $2.4 million and $2.5 million.
High and low estimates are also calculated using the wider bounds
for estimates of the true percentages of ineligible children and
spouses in the FEHB and PSHB population, and this range is described in
the preceding tables.
Some of the ineligible family members who are not covered by FEHB
or PSHB may qualify and enroll in other federal and state health
insurance programs, affecting federal, state, and personal budgets. OPM
lacks data on effects along these lines.
7. Alternatives
There are no feasible alternatives to regulation, as OPM is
required by law to issue these regulations. As an alternative to the
limited approach in this final rule, OPM could require regular
reverification of all enrollees and covered family members. The rule
does not include such changes for several reasons. First, OPM will have
an opportunity to consider such changes through notice and comment
rulemaking in the FEHB Enrollment Integrity regulation (RIN 3206-AO93)
planned for 2026. Such major policy and operational changes would be
issued after a full notice and comment process to be sure all
viewpoints are considered.
Second, OPM is actively planning the family member audit required
by the FEHB Protection Act. OPM expects to use knowledge leveraged from
the planning and execution of the audit to inform any family member
reverification process in the future.
E. Regulatory Compliance
1. Administrative Procedure Act
The Administrative Procedure Act (APA) provides that traditional
notice and comment procedures are not required when, as relevant here,
the agency for good cause finds that following those procedures would
be impracticable, unnecessary, or contrary to the public interest, 5
U.S.C. 553(b)(B). These exceptions are also available in OPM
rulemakings. See 5 U.S.C. 1105. OPM finds that notice and comment is
unnecessary because OPM lacks discretion in revising its regulations to
require verification of enrollment eligibility and QLEs. Furthermore,
delaying this final rule to allow public comment would be contrary to
the public interest and is also unnecessary as Federal law already
prohibits the coverage of ineligible individuals. This rule does not
change any eligibility criteria or the Government's ability to remove
ineligible individuals from coverage. Similarly, the rule does not
change an individual's obligation to provide requested documentation to
support a claim of eligibility. Instead, the rule only updates the
circumstances under which the Government is required to verify
eligibility as required by statute. Accordingly, issuing these
regulations as a final rule allows OPM to promptly pursue the
Administration's goal of reducing fraud, waste, and abuse in public
programs ensuring the lawful use of taxpayer dollars. The regulation is
part of the Administration's approach to addressing the program
integrity issues raised by GAO regarding ineligible family member
enrollments. It is in the public interest to ensure taxpayer dollars
for premium payments are only used for eligible and legitimate FEHB
enrollees. Finally, this rule revises regulatory text from a relatively
recent rulemaking addressing roles and responsibilities between OPM and
the
[[Page 32879]]
employing office in the PSHB Program. This revision would not benefit
from public comment as it is a minor technical change concerning
government operations.
2. Regulatory Review
The Office of Information and Regulatory Affairs in the Office of
Management and Budget has designated this as a significant regulatory
action under E.O. 12866 section 3(f). Accordingly, OPM has examined the
impact of this rule as required by Executive Orders 12866 and 13563,
which direct agencies to assess all costs and benefits of available
regulatory alternatives and, if regulation is necessary, to select
regulatory approaches that maximize net benefits (including potential
economic, environmental, public, health, and safety effects,
distributive impacts, and equity). A regulatory impact analysis must be
prepared for rules that have an annual effect on the economy of $100
million or more or adversely affect in a material way the economy, a
sector of the economy, productivity, competition, jobs, the
environment, public health or safety, or State, local, or tribal
governments or communities. This rulemaking is not likely to reach that
threshold. This rule is not an E.O. 14192 regulatory action because it
does not impose any more than de minimis regulatory costs relative to
estimated federal budgetary savings.
3. Regulatory Flexibility Act
The Director of OPM certifies this rulemaking will not have a
significant economic impact on a substantial number of small entities
because the affected entities are federal agencies, employees,
annuitants, and carriers, rather than small entities.
4. Federalism
This rulemaking will not have substantial direct effects on the
States, on the relationship between the national government and the
States, or on distribution of power and responsibilities among the
various levels of government. Therefore, in accordance with Executive
Order 13132, the Director of OPM certifies that this rulemaking does
not have sufficient federalism implications to warrant preparation of a
Federalism Assessment.
5. Civil Justice Reform
This rulemaking meets the applicable standards set forth in section
3(a) and (b)(2) of Executive Order 12988.
6. Unfunded Mandates Reform Act of 1995
Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA)
requires that agencies assess anticipated costs and benefits before
issuing any rule that would impose spending costs on State, local, and
Tribal governments in the aggregate, or on the private sector, in any 1
year of $100 million in 1995 dollars, updated annually for inflation.
In 2025, that threshold was approximately $206 million. This rulemaking
will not result in the expenditure by State, local, or tribal
governments, in the aggregate, or by the private sector, in excess of
the threshold. Thus, no written assessment of unfunded mandates is
required.
7. Congressional Review Act
The Office of Management and Budget's (OMB) Office of Information
and Regulatory Affairs has determined that this is not a ``major rule''
as defined by the Congressional Review Act (5 U.S.C. 804(2)). OPM will
submit to Congress and the Comptroller General of the United States a
report regarding the issuance of this action.
8. Paperwork Reduction Act
Notwithstanding any other provision of law, no person is required
to respond to, nor shall any person be subject to a penalty for failure
to comply with a collection of information subject to the requirements
of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) (PRA),
unless that collection of information displays a currently valid OMB
Control Number.
This rule is tied to a current OPM approved information collection
3206-0160 SF 2809 Federal Employees Health Benefits Program Election
Form; OPM 2809 Health Benefits Election Form. Access to the current
version of the collection--including all supporting materials--can be
found at <a href="http://www.reginfo.gov">www.reginfo.gov</a> by searching for the collection by the OMB
Control Number or the title. The combined total burden hour estimate
for the two forms is estimated to be 20,667 hours for 48,000 responses.
OPM has published a 60-day notice of updates to this information
collection at 91 FR 32135 on May 29, 2026. This notice proposes
updating the information collection and calls for comment.
A list of routine uses associated with these forms can be found in
the Privacy Act System of Records Notice (SORN), OPM/Central-23 FEHB
Program Enrollment Records, available at 89 FR 72902 (September 6,
2024) at <a href="https://www.federalregister.gov/d/2024-20061">https://www.federalregister.gov/d/2024-20061</a>.
9. Severability
If any of the provisions of this final rule is held to be invalid
or unenforceable by its terms, or as applied to any person or
circumstance, it shall be severable from the remaining sections and
shall not affect the remainder thereof or the application of the
provision to other persons not similarly situated or to other
dissimilar circumstances.
List of Subjects in 5 CFR Part 890
Administrative practice and procedure, Government employees, Health
facilities, Health insurance, Health professions, Indians, Military
personnel, Postal Service, Reporting and recordkeeping requirements,
Retirement.
Signing Statement
The Director of OPM, Scott Kupor, reviewed and approved this
document and has authorized the undersigned to electronically sign and
submit this document to the Office of the Federal Register for
publication.
Office of Personnel Management.
Jerson Matias,
Federal Register Liaison.
For reasons stated in the preamble, OPM amends 5 CFR part 890 as
follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
0
1. The authority citation for part 890 is revised to read as follows:
Authority: 5 U.S.C. 8913. Sec. 890.102 also issued under
sections 11202(f), 11232(e), and 11246(b) of Pub. L. 105-33, 111
Stat. 251. Sec. 890.111 also issued under 36 U.S.C. 5522. Sec.
890.112 also issued under 2 U.S.C. 2051. Sec. 890.113 also issued
under section 1110 of Pub. L. 116-92, 133 Stat. 1198 (5 U.S.C. 8702
note). Sec. 890.301 also issued under 26 U.S.C. 9801. Sec.
890.302(b) also issued under 42 U.S.C. 300gg-14. Sec. 890.803 also
issued under 50 U.S.C. 3516 (formerly 50 U.S.C. 403p); 22 U.S.C.
4069c and 4069c-1. Subpart L also issued under section 599C of Pub.
L. 101-513, 104 Stat. 2064 (5 U.S.C. 5561 note). Subpart M also
issued under 10 U.S.C. 1108; 25 U.S.C. 1647b. Subpart P also issued
under 5 U.S.C. 8903c.
Subpart C--Enrollment
0
2. Amend Sec. 890.302 by revising paragraph (a)(1) to read as follows:
Sec. 890.302 Coverage of family members.
(a)(1) Enrollment. An enrollment for self plus one includes the
enrollee and one eligible family member. An enrollment for self and
family includes all family members who are eligible to be covered by
the enrollment except as
[[Page 32880]]
provided in Sec. 890.308(h). Except as provided in paragraph (a)(2) of
this section, no employee, former employee, annuitant, child or former
spouse may enroll or be covered as a family member if he or she is
already covered under another person's self plus one or self and family
enrollment in the FEHB Program.
(i) Verifying family member eligibility. The enrollee must provide
proof of family member eligibility to the employing office, the
carrier, or OPM, as specified by OPM, at the time a family member is
added to an enrollment, including during an initial opportunity to
enroll, any open season, due to a qualifying life event, or at any
other time a family member is added. Proof of family member eligibility
must also be provided upon request to the carrier, the employing
office, or OPM as provided in Sec. Sec. 890.308(e) or (f) and
890.1608.
(ii) Verifying a qualifying life event. When an enrollee seeks to
add a family member based on a qualifying life event, the enrollee must
provide proper documentation to the employing office, the carrier, or
OPM, as specified by OPM, to verify the veracity of any qualifying life
event before a covered family member may be added to the enrollment.
Qualifying life events are described in Sec. 892.101 of this chapter
or Sec. 890.301.
* * * * *
Subpart P--Postal Service Health Benefits Program
0
3. Amend Sec. 890.1607 by revising paragraphs (b)(1) and (2) to read
as follows:
Sec. 890.1607 Initial decision and reconsideration.
* * * * *
(b) * * *
(1) Except as otherwise provided in this subpart, employing offices
are responsible for initial decisions concerning PSHB eligibility for
Postal Service employees or Postal Service annuitants and for
verification that an individual is an eligible member of family under
Sec. 890.302.
(2) OPM is responsible for initial decisions concerning:
(i) Postal Service annuitants or their family members who are not
required to enroll in VA's system of patient enrollment referred to in
38 U.S.C. 1705(a), and who must provide documentation from the VA under
Sec. 890.1604(d)(2) indicating they satisfy the requirements for an
exception described in Sec. 890.1604(c)(1)(iv) or (c)(2)(iii); and
(ii) Postal Service annuitants or their family members who must
provide documentation from the Indian Health Service under Sec.
890.1604(d)(3) indicating they satisfy the requirements for an
exception described in Sec. 890.1604(c)(1)(v) or (c)(2)(iv).
* * * * *
[FR Doc. 2026-11022 Filed 5-29-26; 4:15 pm]
BILLING CODE 6325-63-P
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