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Changes in Health Coverage

Federal Employees Health Benefits Program

The Health Insurance Marketplace does not affect your enrollment under the Federal Employees Health Benefits (FEHB) Program.

If you are an eligible Federal employee, the FEHB Program can help you meet your and your family’s health care needs. Federal employees, retirees and their dependents enjoy a broad  selection of health plans. You can choose from among Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, Fee-for-Service (FFS) plans with Preferred Provider Organizations (PPO), and Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan.

You can use the Plan Comparison Tool to compare the costs, benefits, and features of different FEHB plans. When choosing a health plan, we urge you to consider the total benefit package, including service, cost, and provider availability.

FEHB plan brochures describe the services and supplies covered by each plan, as well as the level of coverage. We recommend that you review the brochures carefully so that you fully understand the scope of coverage for a plan you are considering. You can get plan brochures from the health plans, your human resource office, or on the OPM website. In addition, you can view brief Summaries of Benefits and Coverage (SBC) for FEHB plans to help inform your health insurance decision.

If you are enrolled in the FEHB Program, you do not need to take any action regarding your FEHB enrollment or the Health Insurance Marketplace. You and your covered family members under your FEHB plan meet the individual shared responsibility requirement for insurance coverage under the Affordable Care Act.

Health Insurance Marketplace

The Health Insurance Marketplace (the Marketplace) is a coverage option separate from the FEHB Program that is intended for Americans who do not have access to affordable, comprehensive health insurance (in some states the Marketplace is also known as the "Exchange").

You may wish to consider enrolling in a plan through the Marketplace if you are ineligible to enroll in the FEHB Program. With one application, you can see all your options and enroll. When you use the Marketplace, you will fill out an application and find out if you can get lower costs on your monthly premiums for private insurance plans. You will also find out if you qualify for lower out-of-pocket costs.

The Marketplace will tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP). Plans and prices will be available when open enrollment begins October 1, 2013. Coverage availability starts January 1, 2014.

In some states, the Marketplace will include health plan options that are part of OPM’s new Multi-State Plan Program (MSPP). The MSPP is a program established under the Affordable Care Act.  OPM is contracting with private health insurance issuers to offer MSPP choices in over 30 states.  These MSPP choices will be available for enrollment by eligible individuals and small businesses beginning this October.  Coverage availability starts January 1, 2014.  To learn more about the MSPP, visit the Multi-State Plan Program site.

You can compare options in the Marketplace, learn about the Marketplace in your state, get health coverage and find a plan that fits your needs and budget by calling 1-800-318-2596, twenty-four hours a day, seven days a week (TTY: 1-855-889-4325), or by visiting Healthcare.gov.

Members of Congress and Congressional Staff

Under final rules issued by OPM to implement a provision of the Affordable Care Act, Members of Congress and designated congressional staff must purchase coverage on the Marketplace.  OPM has determined the most appropriate Marketplace is 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 D.C., 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, visit OPM's webpage for Members of Congress.

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