Health Coverage Certification for Grandchildren

This document provides the necessary certification to indicate that a member has met the following requirements for coverage of a grandchild who qualifies as a foster child under the Federal Employees' Health Benefits (FEHB) Program or the District of Columbia Employees' Health Benefits (DCEHB) Program:

• The child must be unmarried and under age 26 (if 26 or older, the child can only be covered if he/she is incapable of self-support because of a disability that began before age 26. Documentation of this instance must be provided to DCRB);
• The child must currently live with the member;
• The member must currently be the primary source of financial support for the child;
• The parent-child relationship must be with the member and not the biological parent. This means that the member exercises parental authority, responsibility, and control, and that the member also cares for, supports, disciplines, and guides the child. The member also makes decisions about the child’s education and health care; and
• The member expects to raise the child into adulthood.

You can send the completed form and any required attachments by fax to (202) 566 -5001 or by mailing your documents to:

DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001

If you have further questions, please contact the DCRB Member Services Center by clicking on the Ask Member Services link, or by phone at (202) 343-3272 Monday – Friday from 8:30 am to 5:00 pm.