Each year during the month of September, Members of Congress may submit a letter for the following calendar year to the administrative office denoting which employees of their staff are “official office” staff and/or not “official office” staff.

House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through the Small Business Health Options Program (SHOP).  SHOPs were established to administer group health benefits to employees of small businesses.  Given the location of Congress in Washington DC, OPM has determined that the DC SHOP, known as the DC Health Link Small Business Market administered by the DC Health Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and designated congressional staff will purchase health insurance in order to receive a government contribution.  For more information, please visit OPM's webpage for Members of Congress.  

FEHB will be the primary payor.  As stated in the Primary Payor Chart in Section 9, Coordinating Benefits with Medicare and Other Coverage, of the FEHB plan brochures, the rule regarding reemployed annuitants is that FEHB pays first if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link).  Though Members of Congress and designated congressional staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  Therefore, the same FEHB rules for who is primary payor for other Federal reemployed annuitants apply to Members of Congress and designated congressional staff. It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB (including DC Health Link) eligibility.  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.  

The FEHB rule regarding reemployed annuitants and whether an OPM-contracted FEHB plan or Medicare pays first is that if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link), the FEHB plan will be first payor.  Though Members of Congress and designated staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  The same FEHB rules for who is first payor in situations involving an OPM-contracted FEHB plan will apply for DC Health Link plans and the DC Health Link plan will pay first, before Medicare. It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB eligibility (including DC Health Link).  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

Members of Congress will determine which of their staff members work in the official office.  Members may delegate this responsibility to the House or Senate Administrative Offices.  Those staff members that are designated as working in the official office must choose health plans from the DC Health Link.

Affordable Care Act, Section 1312, defines congressional staff as all full-time and part-time employees employed by the official office of a Member of Congress. Therefore, staff who do not work for the official office of a Member will remain eligible for OPM-contracted FEHB plan coverage.

For questions regarding eligibility, staff designation, employer contribution, or retirement: House of Representatives: The House of Representatives Office of Payroll and Benefits can be reached Monday – Friday from 8:30am – 5:30pm EST at 202-225-1435. The House of Representatives Office of Members’ Services can be reached Monday – Friday from 8:30am – 5:30pm EST at (202) 225-3644. Senate: The Senate Disbursing Office can be reached Monday – Friday from 9:00am – 5:30pm EST at (202) 224-1093. For questions regarding plan benefits and provider networks: For an overview of plans, benefits, and provider networks, see the Gold Plan document. For additional information on health plans, contact the health insurance company directly: Aetna: (800) 544-0526; www.aetna.com/employer-plans/small-business/states/DC-exchange.html CareFirst BlueCross BlueShield: (855) 541-3985; www.CongressandCareFirstBCBS.org Kaiser Permanente: (855) 251-3209; www.kp.org/feds United Healthcare: (877) 856-2430; www.myuhc.com  

Yes.  As long as they meet other eligibility requirements, the former spouses of Members of Congress and designated congressional staff are eligible for Spouse Equity Act coverage.  For more information about Spouse Equity Act, please see the OPM Former Spouse webpage and the Former Spouse section in the FEHB Handbook. 

Designations must be made in the September before the plan year begins. Designations will be effective for the entire plan year.

The purpose of the 31-day extension is to provide time for enrollees to select another health plan when their current OPM-contracted FEHB coverage is terminated.  If you choose not to enroll in an employer-sponsored health benefits plan via the DC Health Link, an additional 31 days of coverage is included at no cost to you after the date that your OPM-contracted FEHB enrollment is terminated.  If you DO choose to enroll in an employer-sponsored health benefits plan via the DC Health Link with a government contribution, your DC Health Link enrollment the 31-day extension of coverage will not apply. 

You can find out more information about SHOP generally at www.healthcare.gov.  You can view information about the DC SHOP at www.DCHealthLink.com. 

The Small Business Health Options Program (SHOP) is a program under the Affordable Care Act (ACA) that simplifies the process of buying health insurance for small businesses. House of Representatives and Senate offices will provide health coverage to Members of Congress and designated congressional staff through the DC Health Exchange SHOP, known as DC Health Link. Members of Congress and designated staff can select coverage through the DC Health Link.

A SHOP is designed specifically for employer-sponsored health insurance coverage, whereas the individual Exchanges are designed for individual health coverage that is not tied to one’s employment.

Your FEHB coverage will terminate at midnight on December 31 of the current year and your DC Health Link coverage will be effective January 1 of the next plan year.

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.

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).

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.

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. 

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.

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:

1. Your name, date of birth, and Social Security Number;
2. Employer name (i.e., Senate or House);
3. QLE (e.g., marriage);
4. Date of change (e.g., date of marriage);
5. What you want to do (e.g. enroll in coverage, drop your coverage, add/remove a family member); and
6. 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.

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.

“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.   

No.  Health benefits plans purchased via the DC Health Link do not have an extension of coverage provision in their benefits coverage

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.

If you are a new hire, your Benefits Office will notify you when your plan options are available to view on www.DCHealthLink.com.

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. 

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.

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.

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.

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.

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.

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.

 

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. 

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.  

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.

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.)

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.

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.  

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.

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.

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).

No federal funds, including administrative funds, will be used to cover abortions or administer plans that cover abortions.  

Yes.  All plans offered by Aetna as well as the CareFirst Multi-State plan do not offer elective abortion services. Aetna plan provider networks are available in all states except Alaska, Iowa, Idaho, South Dakota, Wyoming, Montana, and Hawaii.  The CareFirst Multi-State plan provider network is available in all 50 states and the U.S. Territories. 

Washington, DC via DC Health Link (www.DCHealthLink.com).

No.  Most plans do NOT offer routine dental and vision care for Adults. You should check your plan benefits and if dental and vision care is not covered, consider enrolling in a supplemental plan for adult coverage.  You can view information about the Federal Employees Dental and Vision Insurance (FEDVIP) plans at www.benefeds.com.

In order to receive a government contribution towards your premium, you must select from among the Gold metal level plans available via the DC Health Link.  The DC Health Link requires that employers offering employees a choice of multiple plans and issuers must limit those choices to all plans within a single metal level.  Congress, following guidance from OPM regarding the actuarial value of FEHB benefits, will be allowing its employees to choose among Gold metal level plans, as those are most comparable to the OPM-contracted FEHB plans offered to other federal employees.

All DC Health Link plans must cover a comprehensive package of "essential health benefits" (EHB).  DC Health Link’s benefits are based on those covered in the most popular small group health insurance policy currently sold in the District market.  The benefits cover:

• Doctor visits
• Hospital stays
• Emergency room care
• Maternity and newborn care
• Prescription drugs
• Lab tests
• Preventive tests and services
• Rehabilitative and habilitative services and devices
• Chronic disease management
• Mental health care
• Substance use disorder services
• Dental care for children
• Vision care for children

OPM has notified all issuers on the DC Health Link of the requirement to segregate federal funds in order to ensure that no portion of the government contribution towards the health care premium for a Member of Congress or congressional staff goes toward the cost of providing or administering elective abortion services.  Issuers have been asked to follow the same segregation requirements as they do for the individual Exchanges, found in 45 C.F.R. §156.280. 

When comparing plans on the DC Health Link, you will see a link to a list of providers in each plan’s provider network.  It is very important that you evaluate the availability of each plan’s provider network in the area you live or the area you access healthcare prior to selecting a plan.  Some plans may only provide benefits if you use in-network providers.  If staying with your current doctors is important to you, check to see if they are included before choosing a plan.  You may also contact the health insurance carrier for any questions about the provider network or whether a specific provider is covered by a particular plan.

Yes.  However, all issuers offering such coverage must segregate federal funds to ensure the portion of the premium that goes towards elective abortion services and any associated administrative costs comes from premiums contributed by the employee, not from the government contribution. 

Information about the range of approved premiums for DC Health Link product types is available at https://disb.dc.gov/2015rates or http://disb.dc.gov/sites/default/files/dc/sites/disb/publication/attachments/9-15-14-Small-Business-SHOP-Approved-Rates-for-Health-Insurance-Products-Sold-on-DC-Health-Link-for-2015.pdf .

Like other Members of Congress and congressional staff, representatives from U.S. Territories and their designated staff must enroll for coverage under the DC Health Link in order to receive a government contribution.  The DC Health Link offers health plan options with access to in-network medical providers across the nation and overseas.  There will be plans offered by at least one health insurance issuer in all territories.

Yes.  This is your only option for employer-sponsored coverage through your position with the House of Representatives or Senate.  It is very important that you evaluate the availability of each plan’s provider network in the area where you expect to use health care services prior to selecting your health plan.  Some DC Health Link plans only offer coverage in the DC Metro area and some plans may only offer benefits coverage for in-network providers.  

Yes.  This is your only option for employer-sponsored coverage through your position with the House of Representatives or Senate.  It is very important that you evaluate the availability of each plan’s provider network in the area where you expect to use health care services prior to selecting your health plan.  Some DC Health Link plans only offer coverage in the DC Metro area and some plans may only offer benefits coverage for in-network providers.  

Yes.  The DC Health Benefit Exchange Authority will post a PDF of each SBC for plans available on the DC Health Link at www.DCHealthLink.com.  These SBCs will be posted prior to open enrollment, which begins in mid-November.

Members of Congress and designated staff will choose from plans on the Gold Metal Level of the DC Health Link.  While all plans have the same “essential health benefits” (EHB), plans vary in copays, coinsurance, deductibles, and benefits beyond the EHB.  Plans include fee-for-service, HMOs, Point of Service, and HSA-compatible plans. 

DC Health Link offers health insurance for Members of Congress and designated congressional staff through four carriers – Aetna, Carefirst BCBS, Kaiser Permanente, and United Health Care.  Each carrier offers a variety of plan options. For the total number of plans available, please visit www.DCHealthLink.com.

Yes, so long as they purchase coverage via the DC Health Link SHOP Marketplace.

Premiums are based on the age of each family member being covered as of the effective date of coverage and the plan chosen. Family premiums include up to 3 children under age 21 – any additional children under age 21 are covered at no additional premium cost.

Premiums will be collected by payroll deduction.

No.  The federal government does not provide employer contributions directly to your HSA.  The standard employer contribution will be paid towards your DC Health Link premium.  In addition, you may contribute directly to your HSA and deduct as per IRS guidance.

No.  Members of Congress and staff receiving the employer contribution from the federal government are not eligible to receive tax credits for coverage purchased through a DC Health Link SHOP.

Generally, your enrollment and your government contribution may continue for up to 365 days of leave without pay unless you want it to terminate or do not respond to your employing office's notice about continuing coverage during a period in leave without pay status.  You must pay the employee share of premiums for every pay period that your enrollment continues.

To enroll in a DC Health Link plan:

1. Create an account at www.DCHealthLink.com
2. Select the “Apply for health coverage offered by your employer through DC Health Link” link to sign up as an employee.
3. Enter information about your and any eligible family members you would like covered under your plan.
4. Click the “Enroll in a Plan” button on the DC Health Link page to begin shopping
5. Review the available health plans, the plan SBCs, the provider network, and your monthly employee cost.
6. Select your health plan and sign the enrollment application.
7. Enrollment is complete when you receive a “Congratulations” page.

If you choose to sign up for a plan on your State’s individual Marketplace (as opposed to the DC Health Link SHOP), you will not get a government contribution, your premiums will not be withheld from pay and will not be pre-tax, and you may not be able to carry FEHB into retirement. 

Your employer will begin withholding after DC Health Link notifies them of your enrollment and premium amount.  Often this information is received well after the effective date, so any retroactive premium amounts will be withheld from pay.  Employees should prepare for this retroactive withholding.

Generally employees in that status may continue their employer-sponsored DC Health Link coverage for up to 2 years.  The employer continues to pay the employer contribution for the first year and pays the employee contribution on the employee’s behalf. The employee encounters a debt for the employee portion.  For the second year, the employer pays the entire premium on the employee’s behalf.  The employee incurs a debt for the entire premium amount.  Based on USERRA, the employer may choose to waive this debt if the employee returns to service with the agency within the requirements set forth in USERRA. Check with your agency’s benefits officer if you have questions on this.  You may also choose to cancel your DC Health Link coverage based on LWOP-Military and you may choose to re-enroll upon your return from active duty

You can determine your monthly premium by visiting www.DCHealthLink.com, creating an application and shopping for coverage.  When you shop for plans, you will be able to see the monthly employee contribution, as well as the employer contribution and total monthly premium.

When using the OPM Premium Contribution Calculator, you need to choose either Self or Self+ to determine your monthly premium.  These are terms used for purposes of the Premium Contribution Calculator only.  These terms indicate whether you are selecting coverage only for yourself (Self enrollment) or for yourself and any other eligible family members (Self+ enrollment).

The government contribution will be based on the same formula used for other federal employees.  The government contribution equals the lesser of: (1) 75% of the total premium for the particular SHOP plan an enrollee selects ; or (2) 72% of amounts OPM determines are the FEHB program-wide weighted average of premiums in effect each year, for Self Only and for Self and Family enrollments.  

Yes.  Employee contributions will be treated as pre-tax when enrolled in health plans in the DC Health Link.

No. Most Federal employees are eligible for Federal Employee Health Benefits (FEHB) Program. The Affordable Care Act requires OPM to maintain separation between the FEHB Program and the MSP Program; however, both programs benefits from the customer service and oversight that OPM provides.

FEHB will be the primary payor.  As stated in the Primary Payor Chart in Section 9, Coordinating Benefits with Medicare and Other Coverage, of the FEHB plan brochures, the rule regarding reemployed annuitants is that FEHB pays first if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link).  Though Members of Congress and designated congressional staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  Therefore, the same FEHB rules for who is primary payor for other Federal reemployed annuitants apply to Members of Congress and designated congressional staff. It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB (including DC Health Link) eligibility.  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.  

The FEHB rule regarding reemployed annuitants and whether an OPM-contracted FEHB plan or Medicare pays first is that if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link), the FEHB plan will be first payor.  Though Members of Congress and designated staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  The same FEHB rules for who is first payor in situations involving an OPM-contracted FEHB plan will apply for DC Health Link plans and the DC Health Link plan will pay first, before Medicare. It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB eligibility (including DC Health Link).  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

Upon your retirement, coverage under DC Health Link will terminate at the end of the month in which you retire.  If you have met all the requirements for continuation of employer-sponsored health coverage into retirement, including the 5-year rule, you will have the option to select coverage from the same plans offered by OPM to other federal annuitants. To be eligible to continue FEHB in retirement,

1. you must be eligible to receive an immediate annuity; and
2. you must have been continuously covered by the FEHB Program (including DC Health Link), TRICARE, and/or CHAMPUS:

• for the five years of employment immediately preceding your retirement; or,
• during all of your federal employment since your first opportunity to enroll (if employed or eligible less than five years).

If your annuity effective date is on the first of the month, this transition will occur immediately.  If your annuity effective date is not the first of a month, your DC Health Link coverage will continue to the end of the month and the OPM-contracted FEHB plan of your choice will begin the first of the next month.  You will continue receiving a government contribution in retirement.  For more information, please contact your agency’s benefits officer.

If you are a Member of Congress or designated congressional staff, you will be required to purchase a health benefits plan through the DC Health Link in order to receive a government contribution towards your premium.  DC Health Link SHOP coverage is not subject to the same limitation as the individual Exchange which precludes an individual from carrying both Medicare and an individual Exchange policy.  You can continue to have Medicare coverage in addition to your employer-sponsored DC Health Link plan.  The DC Health Link plan will be your primary coverage and Medicare will be secondary.  Please note that if you elect not to enroll through DC Health Link, you may not be eligible to carry OPM-contracted FEHB health benefits into retirement with a government contribution. 

Under Medicare rules, the DC Health Link coverage will be the primary payer and Medicare will be the secondary payer.

  If your spouse is a federal employee enrolled in the FEHB Program with a Self and Family enrollment, the time you spend employed and covered as his or her eligible family member counts towards your requirement to carry FEHB into retirement. If your spouse is not a federal employee and you will no longer be covered under an FEHB plan, you may not be eligible to carry FEHB into retirement unless you subsequently meet the 5-year coverage rule.  Please consult with your agency’s benefits officer before making this IMPORTANT decision.   

No.  Because you are enrolled in an employer-sponsored health benefits plan which has credible coverage, you can delay enrolling in Medicare Part B, without incurring a late enrollment penalty, while you remain enrolled and actively employed. 

As long as your spouse is otherwise eligible for a survivor annuity, he or she will be eligible to enroll in an OPM-contracted FEHB plan.  Please contact your agency’s benefits officer for more information.

Yes. For more information, please contact your employer’s benefits officer.

The “designation” process has no impact on FLTCIP eligibility.  For more information, please contact your agency’s benefits officer.

The “designation” process has no impact on FEGLI eligibility.  For more information, please contact your agency’s benefits officer.  

• Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
• Parents
• Siblings
• In-laws

  Which family members are eligible for Federal Employees Health Benefits?   

• A spouse, including a valid common law marriage.
• Children under age 26 (including adopted children, recognized natural children or stepchildren(including children of same-sex domestic partners in certain states); or foster children living with tribal employee in regular parent-child relationship>
• Children age 26 or older incapable of self-support, if disabling condition began before age 26

Upon turning age 26 and losing FEHB coverage, you may:

• Enroll in TCC. Please see Temporary Continuation of Coverage for more information: http://www.opm.gov/healthcare-insurance/healthcare/temporary-continuation-of-coverage/
• Purchase insurance on the Marketplace. Please visit Healthcare.gov  for more information: http://www.healthcare.gov

Yes. You will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.

For more information, please visit Health Care Reform. * Note: Under provisions of the Affordable Care Act effective January 2014, you must have minimum essential health coverage or you may have to make a payment when filing your Federal income tax return. For more information, please visit www.IRS.gov.

Yes. Former Spouse will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.

Yes. Former employees will have a 31-day temporary extension of coverage at no cost after coverage ends. For more information about the 31-day extension of coverage, please view the Extension of Coverage section in the FEHB Handbook.

• Grandchildren, unless foster child requirements (as defined in the Handbook) are met.
• Parents
• Siblings
• In-laws

  Which family members are eligible for Federal Employees Health Benefits?   

• A spouse, including a valid common law marriage.
• Children under age 26 (including adopted children, recognized natural children or stepchildren(including children of same-sex domestic partners in certain states); or foster children living with tribal employee in regular parent-child relationship>
• Children age 26 or older incapable of self-support, if disabling condition began before age 26

FEHB law dictates which Federal employees are eligible for FEHB coverage based on the type of appointment you have and your scheduled work hours. For more information, please visit the Eligibility Section of the FEHB Handbook.

If you are ineligible for FEHB, you may purchase insurance on the Marketplace. Please visit www.Healthcare.gov for more information. * Note: Under provisions of the ACA effective January 2014, you must have insurance of some sort or will have to pay a tax penalty. For more information, please visit www.IRS.gov