The FEHB Protection Act of 2025 aims to improve the integrity of the Federal Employees Health Benefits (FEHB) Program by verifying the eligibility of family members enrolled in health plans, conducting audits, and providing funding for oversight and audit activities.
Glenn Grothman
Representative
WI-6
The FEHB Protection Act of 2025 aims to improve the integrity of the Federal Employees Health Benefits (FEHB) Program by verifying the eligibility of family members enrolled in health plans. It mandates the Director to establish processes for verifying qualifying life events, conduct comprehensive audits of covered family members, and disenroll ineligible individuals. The Act also allocates specific funding for oversight, audits, and the Office of the Inspector General to ensure proper implementation and prevent fraud within the FEHB Program.
FEHB Protection Act of 2025 Mandates Family Member Audits for Federal Employee Health Plans: Checks Begin in One Year
The FEHB Protection Act of 2025 is all about tightening up who gets covered under the Federal Employees Health Benefits (FEHB) Program. The core purpose? To make sure that only eligible family members are actually receiving benefits, cutting down on potential fraud and misuse of the system. This means verifying that spouses, children, and other dependents listed on federal employees' health plans actually qualify.
Diving Deep into Dependent Eligibility
This bill, straight up, requires the Office of Personnel Management (OPM) to start verifying "qualifying life events." Think getting married, having a baby, or adopting – the events that allow you to add family members to your health plan outside of the normal open season. Within one year, the OPM has to set up a system to check the legitimacy of these events and confirm that the people being added are, in fact, eligible family members as defined by the program (SEC. 2). They'll be looking at things like marriage certificates and birth certificates to make sure everything's on the up-and-up.
It also means that if you're a federal employee with family members on your plan, get ready for a possible audit. Within three years, starting one year after this Act is enacted, the OPM, along with each federal agency, has to do a full check of all family members covered under FEHB plans. They'll be reviewing documentation to confirm everyone's eligibility (SEC. 2). If someone is found to be ineligible, the OPM has six months to get a process in place to remove them from the plan (SEC. 2).
Show Me the Money
The bill sets aside a chunk of change to make all this happen. Starting in fiscal year 2026, tens of millions of dollars are allocated each year for the OPM to oversee enrollment and eligibility, with the amount increasing by 2.2% annually after 2035 (SEC. 3). On top of that, a cool $80 million is earmarked in 2026 specifically for these audits (SEC. 3). The Office of the Inspector General also gets a budget increase, starting at over $5 million in 2026 and rising by 2.2% each year after, to keep an eye on the whole process (SEC. 3).
The Real-World Rundown
For federal employees, this means a bit more scrutiny when adding family members. Imagine you're a park ranger who just got married and wants to add your spouse to your health plan. Under this bill, you'll need to provide solid proof of your marriage, like a certified copy of your marriage license. It's an extra step, but it's designed to ensure the system isn't being taken advantage of. Or, picture a federal contractor whose child turns 26 and is no longer eligible for coverage. This law aims to catch those situations and make sure the rules are followed. While it might seem like a hassle, the goal is to keep the program sustainable and fair for everyone who truly qualifies.