FEHB Protection Act of 2025

The FEHB Protection Act of 2025 aims to strengthen the integrity of the Federal Employees Health Benefits (FEHB) program by requiring the Office of Personnel Management (OPM) to implement rigorous eligibility verification measures. Within one year of enactment, OPM must establish regulations and processes to verify the legitimacy of qualifying life events used to add family members and confirm that all added individuals are indeed qualifying family members. This includes checks during both special enrollment periods and the annual open season.

The bill further mandates that any future fraud risk assessments for the FEHB program specifically evaluate the presence of ineligible individuals. A comprehensive, three-year audit of family member eligibility is also required, starting one year after enactment, where OPM will review documents like marriage and birth certificates. Additionally, OPM must develop a process within six months to promptly disenroll or remove any individual found to be ineligible for coverage under an FEHB health benefits plan.

To support these initiatives, the Act amends existing law to provide dedicated funding for OPM's oversight activities. It allocates specific annual amounts, beginning in fiscal year 2026, for OPM to develop and maintain robust enrollment and eligibility systems for the FEHB program, including the Postal Service Health Benefits Program. An additional $80,000,000 is specifically provided in fiscal year 2026 to fund the comprehensive family member eligibility audit.

The bill also ensures enhanced oversight by the OPM Office of the Inspector General (OIG), providing dedicated annual funding, starting in fiscal year 2026, for oversight related to FEHB activities, including enrollment, eligibility, and the audit mandated by this Act, thereby ensuring sustained resources for program integrity.