New OPM Rule Requires Family Eligibility Proof for FEHB Every Time

A new Office of Personnel Management (OPM) rule now requires federal employees to prove a family member's eligibility every time that person is added to Federal Employees Health Benefits (FEHB) or Postal Service Health Benefits (PSHB) coverage — not just once, and not only after a marriage or a birth.

The rule (91 Fed. Reg. 32,875) took effect July 2, 2026, implementing Section 90101 of the FEHB Protection Act of 2025. It responds to a 2022 Government Accountability Office finding that ineligible family members were receiving FEHB benefits with no verification mechanism in place.

What the New Verification Rule Requires

Under the rule, adding a family member to your FEHB or PSHB coverage now requires two separate kinds of proof: documentation that a qualifying life event occurred (such as a marriage or birth), and separate documentation that the new family member is actually eligible for coverage. This applies even during Open Season, when enrollees have historically been able to make coverage changes without submitting proof of eligibility. The requirement is codified at 5 C.F.R. § 890.308 (5 C.F.R. § 890.1608 for the PSHB Program).

The Documents OPM Will Accept

Acceptable proof varies by relationship:

• A government-issued marriage certificate for a spouse

• A government-issued birth certificate for a child

• Adoption or foster paperwork, where applicable

• Tax returns for adult children under 26

• A medical certification of incapacity for self-support, for a disabled adult child

What Happens if Documentation Falls Short

If the documentation you submit isn't adequate, your employing office, OPM, or your health plan's carrier can remove that family member from your enrollment. If that happens, you have 60 days from the initial decision to request reconsideration — and the reconsideration decision is final within the agency, so the window matters.

What to Do Before This Fall's Open Season

Because this rule applies to every addition going forward — not just new qualifying life events — the practical move is to gather your documents now: marriage certificates, birth certificates, and any adoption, foster, or adult-child paperwork you might need. Having them ready before Open Season, rather than scrambling once a deadline is already running, is the difference between a routine enrollment and a rushed one.

If a family member is removed from your FEHB or PSHB coverage for insufficient documentation, the 60-day reconsideration window moves quickly, and getting it right the first time matters. Southworth PC's attorneys for federal employees can help you understand what a reconsideration request needs and whether your timeline still allows for one.

Legal Disclaimer: This content is for general informational purposes only and does not constitute legal advice. Federal employment situations are fact-specific and time-sensitive. Please consult a qualified federal employment attorney about your specific situation.