Government health insurance program participants will soon face new requirements for adding family members to their plans.
A final rule from the Office of Personnel Management (OPM), set to be released in the Federal Register on Tuesday, will enhance the verification process for the families of insured individuals. This rule impacts participants in the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs.
Starting in July, those enrolled in FEHB and PSHB will need to provide documentation—like marriage certificates, tax returns, and birth certificates—proving that family members they add are eligible for benefits. This will apply to members added during open season or after significant life events (like childbirth, adoption, or marriage).
OPM believes these changes will strengthen the integrity of the health insurance program, which serves over 8 million federal employees, retirees, and their families.
“This rule is essential to address the presence of ineligible families within the FEHB program,” OPM stated in the final rule. “Some families do not qualify. We can enhance our ability to identify and remove them from coverage.”
Eligibility for federal health insurance is tied to the relationship with federal enrollees. Children and spouses under 26 are considered dependents under FEHB and PSHB, whereas grandchildren, parents, former spouses, and domestic partners do not qualify for benefits.
OPM projects that about 4 million families will be enrolled in FEHB and PSHB by 2025. They estimate that roughly 3% of these families may be ineligible for benefits.
Families without coverage under federal health insurance contribute to rising premiums and additional administrative costs, according to the Government Accountability Office. A 2019 report from OPM’s Office of Inspector General labeled ineligible FEHB members as a notable area of misconduct.
Concerns regarding family eligibility in the FEHB program escalated after a 2022 GAO report highlighted OPM’s lack of clarity in identifying and removing ineligible families, which could cost the agency nearly $1 billion each year.
In 2024, OPM tried to start eliminating ineligible participants by verifying a random 10% of enrollees. However, the approach was not entirely effective.
“Challenges during the 2024 open season and staffing issues in 2025 led to many agencies not meeting the 10% verification requirement or failing to report as requested by OPM,” the final rule noted.
In 2025, the GAO observed that recent budget cuts within OPM were hindering its efforts to tackle ongoing fraud risks in the FEHB program.
Historically, insurance companies were primarily responsible for enrolling verification until 2018, when OPM introduced new regulations to manage this matter.
The upcoming final rule further develops OPM’s 2018 regulation, now mandating ongoing verification of family member eligibility during open seasons. Previously, proof was only required during qualifying life events, but OPM or the provider could request verification at other times, too.
This new rule also aligns with the FEHB Protection Act, enacted last summer as part of the One Big Beautiful Bill Act, which tasked OPM with developing an eligibility verification process and a strategy to remove ineligible members from the program.
According to the new rule, OPM plans to verify around 100,000 families each year. In addition to this expanded verification process, OPM is preparing an audit of currently enrolled families.
