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Frequently Asked Questions Insurance

Members of Congress & Staff

  • 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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  • 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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  • 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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  • 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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  • 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.  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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  • 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
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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:
    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.
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  • 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.
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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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