FEHB Eligibility
The Patient Protection and Affordable Care Act of 2010 states: (1) tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act; and (2) urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act, are entitled to purchase coverage, rights, and benefits from the Federal Employees Health Benefits (FEHB) Program for their employees.
If a tribe, tribal organization or urban Indian organization participates in FEHB, the tribe employee can elect FEHB coverage, unless their position is excluded by law or regulation. The human resources officer of the tribe, tribal organization, or urban Indian organizations applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. This chapter in the FEHB Handbook for Tribes explains these provisions. Contract employees, retirees, and volunteers will not be eligible to enroll in FEHB.
Temporary Continuation of Coverage (TCC)
TCC is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Tribal Employer shares of the premium) plus a 2 percent administrative charge.
FEHB for Dependents
Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. The tribal employer will look at the child's relationship to the enrollee to determine whether the child is a covered family member.
Civilian Employees on Active Military Duty
If tribe employees keep their FEHB enrollment during military service, they may continue their enrollment for up to 12 months while they are on military duty. They are responsible for the enrollee share of the premium during this period, just like any other employee in leave without pay status. Current Federal law extends the 12-month period an additional 12 months. During this additional period, they must pay both the employee and the tribal employer’s share of the premium, plus an additional 2 percent of the total premium, on a current basis.
The employing office may waive the requirement that tribe employees pay their share of FEHB premiums during all or any part of the 24-month period if their orders show that they are called to active duty in support of a contingency operation. If their employing office waives the premium, it must remit the full premium (employee and agency share) to OPM on a current basis.