FEHB Protection Act of 2025
FEHB Protection Act of 2025 strengthens the controls and oversight of the Federal Employees Health Benefits (FEHB) Program administered by the Director of the Office of Personnel Management (OPM). The bill requires the Director to implement stricter verification of qualifying life events and added family members, expand fraud risk assessments to catch ineligible enrollees, and conduct a comprehensive audit of family member eligibility. It also creates a formal disenrollment process for ineligible enrollees. On the funding side, it establishes dedicated, multi-year oversight and audit funding for OPM (including the FEHB and the Postal Service Health Benefits Program) and directs explicit annual spending levels (with inflationary growth) for relevant offices and the Inspector General, plus a one-time dedicated audit appropriation in FY2026. In short, the bill aims to reduce improper enrollments and fraud in FEHB by tightening eligibility verification, mandating audits, and providing targeted, protected funding to OPM and related oversight bodies to carry out these duties.
Key Points
- 1Verification requirements for life events and added family members: Within one year of enactment, the Director must issue regulations and implement a process to verify the truth of qualifying life events and to confirm that any newly added family member is eligible to be covered under the FEHB Program, including during open seasons.
- 2Expanded fraud risk assessment: Any fraud risk assessment related to the FEHB Program must include an evaluation of individuals enrolled or covered who are not eligible to be enrolled or covered.
- 3Mandatory family eligibility audits: Over a 3-year period beginning one year after enactment, in coordination with employing offices, the Director must conduct a comprehensive audit of all family members covered under FEHB enrollments, reviewing documents like marriage and birth certificates to verify eligibility.
- 4Disenrollment/removal process: Within six months of enactment, the Director must develop a process to disenroll or remove from FEHB enrollment any individual who is not eligible to be enrolled or covered.
- 5Funding and oversight framework: The bill amends FEHB funding to create dedicated, non-cap-regulated oversight and audit funding for the Office of Personnel Management and the Office of Inspector General, with specified annual caps (and inflation-linked growth after 2035). It also authorizes a one-time FY2026 appropriation of $80 million to conduct the mandated audit, and allows transfers to employing offices to carry out the audit. The funding supports oversight of enrollment and eligibility systems, including the Postal Service Health Benefits Program, and remains available until expended.