Summary

Cracks down on ineligible coverage in federal and postal employee health plans by requiring stronger eligibility checks, targeted audits, and a clear process to remove people who don’t qualify. The Office of Personnel Management (OPM) must issue verification rules within a year, add eligibility checks to fraud risk reviews, audit family-member enrollments, and stand up a removal process within six months. Strengthens oversight funding by setting specific annual limits for audit and eligibility oversight activities, creating a one-time $80 million audit fund available in FY2026 until spent, and separately funding the OPM Inspector General for related oversight. These changes cover both the Federal Employees Health Benefits (FEHB) Program and the Postal Service Health Benefits Program.

Key Points

• Requires OPM to issue eligibility verification rules for health plan coverage within 1 year.
• Mandates a multi‑year audit of family‑member enrollments to find and remove ineligible dependents.
• Establishes a removal process for ineligible enrollees within 6 months.
• Integrates eligibility checks into OPM’s fraud risk assessments.
• Amends 5 U.S.C. 8909 to govern how funds can support oversight and eligibility systems.
• Creates a one‑time $80 million FY2026 audit fund, available until expended.
• Authorizes separate funding for the OPM Inspector General to perform related oversight.
• Covers both the FEHB and Postal Service Health Benefits Program.

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