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Frequently Asked Questions Insurance

SHOP Health Coverage

  • 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.
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  • 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. 
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  • 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.
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  • 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. 
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  • 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.
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  • 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
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  • 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.  
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