Insurance FAQs

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

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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.

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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. 

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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.

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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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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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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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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.

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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. 

 

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