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If your plan is no longer offered in the next coverage year, you must enroll in a different plan during the open enrollment to continue coverage. If you do not enroll in a different plan during open enrollment, you will lose SHOP coverage and your Government contribution.
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You have up to 30 days from the date of the event to report your QLE. If the QLE is not reported within this timeframe, you will lose eligibility to make enrollment changes based on the QLE.
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For the birth or adoption of a child, coverage for the child (and other new enrollees) begins on the date of birth or adoption. For other QLEs, coverage begins on the 1st day of the month following the date of the event (e.g., if you married 4/14, coverage for the new spouse starts 5/1). If you are dropping coverage for yourself or a family member, coverage ends on the last day of the month in which the life event occurred (e.g., if an enrolled spouse gets a new job on 4/14 and gains employer coverage, the end date of the spouse's coverage is 4/30).
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If you have a Qualifying Life Event (QLE), you will have 30 days from the date of the event to change plans or change your type of enrollment.
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Once you enroll in a DC Health Link plan, your plan enrollment will continue indefinitely and will automatically renew for each calendar year if you take no action during Open Enrollment, unless an employment change occurs, such as a separation, break in service, or move to another agency with FEHB eligibility. If during a subsequent annual designation period, you are designated as NOT “official office” staff, your coverage would end 12/31 of that year and you would be eligible to elect an OPM-contracted FEHB plan during the Open Enrollment period.
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No. For coverage obtained through the DC Health Link, if you chose to cover your family members, you must all be covered under the same plan.
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You can report a QLE to DC Health Link in two ways:
Option 1: Login to your account on DCHealthLink.com and click on “Update My Information” link. You will be able to select the QLE reason and what type of action you want to take (e.g. add a new dependent). You can also update your address.
Option 2: Contact DC Health Link by phone (855-532-5465) or email (
info@DcHealthLink.com). Please include the following information:
- Your name, date of birth, and Social Security Number;
- Employer name (i.e., Senate or House);
- QLE (e.g., marriage);
- Date of change (e.g., date of marriage);
- What you want to do (e.g. enroll in coverage, drop your coverage, add/remove a family member); and
- If adding/removing a family member, include the family member’s name, gender, relationship (i.e., child or spouse), date of birth, and social security number (if not a newborn).
After you report the QLE, you will be notified within 3 business days to complete a new plan enrollment.
IMPORTANT: Whichever method you choose to report a QLE (other than an address update), you MUST complete a new plan enrollment for your QLE change to take effect. For example, if you want to add a new dependent to your current plan, you must complete plan shopping and select your current health plan.
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TCC will be available to enrolled Members of Congress and designated congressional staff who leave their jobs, as well as eligible family members, with the same rules that apply to TCC for other federal employees and eligible family members. TCC will only be offered through OPM-contracted FEHB plans. Please contact your agency’s benefits officer for more information.
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“Official office” staff designations are made on an annual basis during the designation period for the following calendar year or upon hire, so a mid-year transition would not change your eligibility. Employment in a non-“official office” designated staff position during a subsequent designation period would allow you to select coverage under an OPM-contracted FEHB plan during that Open Enrollment period, but you would continue your DC Health Link coverage through the end of the calendar year.
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No. Health benefits plans purchased via the DC Health Link do not have an extension of coverage provision in their benefits coverage
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Upon separation from the Senate or House of Representatives, your DC Health Link coverage will terminate at the end of the month. If your new position is FEHB-eligible, you will be able to select coverage from the same plans offered by OPM to other federal employees. You do not need to wait until Open Enrollment to enroll in an FEHB plan because your move to a new federal agency constitutes a Qualifying Life Event.
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If you are a new hire, your Benefits Office will notify you when your plan options are available to view on
www.DCHealthLink.com.
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You do not have to take affirmative action to continue coverage under the same DC Health Link plan. Note: You should always check during Open Enrollment to see that your current plan is continuing as a participating plan in DC Health Link for the following calendar year.
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Under FEHB rules, eligible family members are limited to your spouse, your children (including step-children and adopted children), and your foster children. Regardless of the family member relationships listed on the DC Health Link webpage when enrolling, these are the only family members you may enroll.
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Yes. Your FEHB or DC Health Link health coverage with the House of Representatives as your employer will terminate at the end of the month in which your employment terminates. You will need to enroll in a DC Health Link plan with the Senate as your employer in order to continue/begin coverage under DC Health Link. You should be conscious of gaps in coverage and inquire of your losing employer on your TCC needs/rights.
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No. DC Health Link rules allow you to select which of your eligible family members you would like to cover. Remember that the only eligible family members under FEHB rules are spouses and children under age 26 (including legally adopted children, recognized natural children, stepchildren and foster children who meet certain requirements) and children age 26 or over who are incapable of self-support because of a physical or mental disability that existed before the child reached age 26. Note: If you have a court or administrative order to provide coverage for a child, you must include that child in your DC Health Link plan or be able to prove that you have purchased other coverage for him or her.
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SEA eligible former spouses of Members of Congress and designated congressional staff will enroll under an OPM-contracted FEHB plan. For more information about Spouse Equity Act, please see the
OPM Former Spouse webpage and the
Former Spouse section in the FEHB Handbook.
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If you separate from federal service, your DC Health Link coverage will terminate and you will need to buy coverage through a new employer, the individual Marketplace, or elsewhere. You would also be eligible for Temporary Continuation of Coverage (TCC) provided by an OPM-contracted FEHB carrier.
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QLEs include, but are not limited to:
- Marriage;
- Birth or adoption of child; and
- Loss of other coverage. Examples include:
- You were covered under your parents’ coverage and are no longer eligible due to turning 26.
- You, or a family member, were covered under another employer’s plan and are losing eligibility for the other employer’s health plan.
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A newly elected Member of Congress or newly hired designated congressional staff has 30 days to enroll in a DC Health Link plan starting on the later of date of hire or the date their eligibility for DC Health Link is entered by the administrative office to the DC Health Link system (usually 1-3 days after hire). The coverage will be effective on the 1st day of the month following the date of hire. For example, if a Member of Congress or designated congressional staff is hired or entered on April 17, the individual will have until May 16 to enroll. If that person enrolls on May 15, the coverage will be effective retroactively to May 1.
This 30-day rule applies for new hires at any time. For example, if an employee is hired during open season, that person will still have 30 days from the date of hire to enroll, even if open season ends before the 30-day enrollment period ends.
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Because coverage under the DC Health Link is employer-sponsored coverage, your plan coverage will terminate at the end of the month in which you leave your job. You may be eligible for Temporary Continuation of Coverage via an OPM-contracted FEHB plan. Please contact your agency’s benefits officer for more information and view the
OPM Losing & Ineligible for FEHB webpage.
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If your plan is no longer offered in the next coverage year, you can choose to enroll in a different plan during the Open Enrollment. If you do not enroll in a different plan during Open Enrollment, DC Health Link will automatically enroll you in the plan available with the most similar coverage to your plan, as determined by the insurance company in which you are enrolled.
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Generally, yes. After a break in service of four days or more, you will be treated as a new employee. Your new employing Member of Congress will need to designate you as either “official office” staff or not. Your previous enrollment in a health benefits plan will be terminated and you will need to reenroll. However, OPM has determined that if you are reemployed by the same Member of Congress, the annual designation made by that Member will take precedence and your prior designation will not be affected. (In this case, you will still need to reenroll in a DC Health Link plan to have continued coverage.)
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Yes. Your FEHB or DC Health Link health coverage with the House of Representatives as your employer will terminate at the end of the month in which your employment terminates. You will need to enroll in a DC Health Link plan with the Senate as your employer in order to continue/begin coverage under DC Health Link. You should be conscious of gaps in coverage and inquire of your losing employer on your TCC needs/rights.
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Once open enrollment begins, you can sign up for coverage at
www.DCHealthLink.com. If you are a new hire, you may enroll within 30 days of the date you are notified by your administrative office that you have been entered in the DC Health Link system.
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For coverage effective January 1 of the next plan year, you will need to sign up for a DC Health Link health plan during Open Enrollment.
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After the end of the 31-day extension of your FEHB plan coverage, you will no longer have health insurance with a Government contribution. Failing to enroll in a SHOP health plan will also result in a break in coverage that may preclude you from being able to enroll in a FEHB-contracted plan at the time of retirement. You may be able to enroll after Open Enrollment if you experience a Qualifying Life Event. Please contact your administrative office for more information.
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The open enrollment period for Members of Congress and designated staff enrolling in DC Health Link will be the same as the FEHB Open Season, which runs from mid-November until mid-December each year. In addition, Members of Congress and designated congressional staff will be allowed to enroll or make enrollment changes upon being hired or within 30 days upon experiencing a Qualifying Life Event (QLE).
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