Washington, DC - The United States Office of Personnel Management (OPM) has issued a proposed rule to implement the Affordable Care Act (ACA) requirement that Members of Congress and congressional staff employed by the official office of a Member of Congress choose health plans offered through Health Insurance Exchanges (also called Marketplaces). 

Members of Congress and applicable congressional staff will not be eligible for premium tax credits for Exchange plans, but the proposed rule clarifies that the participants will continue to have an employer contribution toward their health insurance premiums.  The amount of the employer contribution toward their Exchange premiums is no more than would otherwise be made toward coverage under the FEHB Program.  

“These proposed regulations implement the administrative aspects of switching Members of Congress and congressional staff to their new insurance plans - the same plans available to millions of Americans through the new Exchanges,” said Jon Foley, OPM Director of Planning and Policy.

The statute defines “congressional staff” to include those who work for “the official office of a Member of Congress.”  Because there is no existing statutory or regulatory definition of the term “official office,” however, the rule proposes that the employing office of the Member of Congress determine whether an employed individual meets the statutory definition.  Each Member of Congress and congressional staff will be able to purchase health plans through individual Marketplace in each State where he or she resides.

Along with the proposed rule, OPM issued a Benefits Administration Letter to the House and Senate administrative offices to provide further guidance on the enrollment of covered individuals into Exchange plans.  OPM staff will be working with relevant administrative staff in the House and Senate to assist with addressing specific issues concerning eligibility, enrollment and payment processes, with the goal being to ensure that Members of Congress and staff have as smooth as possible a transition to plans offered on Exchanges.

FEHBP Information for Members of Congress and Congressional Staff (BAL 13-204) is located at /retirement-services/publications-forms/benefits-administration-letters/#url=2013

Please see individual links below: 

BAL - /retirement-services/publications-forms/benefits-administration-letters/2013/13-204.pdf
Fact Sheet - /retirement-services/publications-forms/benefits-administration-letters/2013/13-204attachment1.pdf   
Q&A - /retirement-services/publications-forms/benefits-administration-letters/2013/13-204attachment2.pdf  

Federal Register Notice - https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-19222.pdf