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Frequently Asked Questions Insurance

Members of Congress & Staff

  • House of Representatives and Senate offices will provide health coverage to Members of Congress and designated staff through 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 DC, 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, please visit OPM's webpage for Members of Congress.  
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  • FEHB will be the primary payor.  As stated in the Primary Payor Chart in Section 9, Coordinating Benefits with Medicare and Other Coverage, of the FEHB plan brochures, the rule regarding reemployed annuitants is that FEHB pays first if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link). 

    Though Members of Congress and designated congressional staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  Therefore, the same FEHB rules for who is primary payor for other Federal reemployed annuitants apply to Members of Congress and designated congressional staff.

    It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB (including DC Health Link) eligibility.  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.


     

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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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  • The FEHB rule regarding reemployed annuitants and whether an OPM-contracted FEHB plan or Medicare pays first is that if the reemployed annuitant is employed in a position that conveys FEHB eligibility (including DC Health Link), the FEHB plan will be first payor. 

    Though Members of Congress and designated staff are now enrolled in DC Health Link plans, and not OPM-contracted FEHB plans, per OPM regulations, these DC Health Link plans are considered to be included under the “FEHB umbrella.”  The same FEHB rules for who is first payor in situations involving an OPM-contracted FEHB plan will apply for DC Health Link plans and the DC Health Link plan will pay first, before Medicare.

    It is important to note that a reemployed annuitant can terminate Medicare Part B enrollment if the reemployed annuitant is in a position that conveys FEHB eligibility (including DC Health Link).  The reemployed annuitant should contact his/her local Social Security Office to inform them that he/she now has health insurance as an active employee.  The reemployed annuitant is entitled to a Special Enrollment Period (SEP) to reenroll in Medicare Part B once he/she retires again.

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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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  • No.  There are separate external appeal provisions that apply to health plans participating in the DC Health Link.  You can contact the Healthcare Ombudsmen at (877) 685-6391, Monday –Friday from 8:15 AM – 4:45 PM EST, or the Department of Insurance Securities & Banking (DISB) at (202) 727-8000, Monday – Friday from 8:15 AM – 4:45 PM EST.  For more information, please contact your agency’s benefits officer.
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  • No federal funds, including administrative funds, will be used to cover abortions or administer plans that cover abortions.  
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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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  • Upon your retirement, coverage under DC Health Link will terminate at the end of the month in which you retire.  If you have met all the requirements for continuation of employer-sponsored health coverage into retirement, including the 5-year rule, you will have the option to select coverage from the same plans offered by OPM to other federal annuitants.

    To be eligible to continue FEHB in retirement,

    1. you must be eligible to receive an immediate annuity; and
    2. you must have been continuously covered by the FEHB Program (including DC Health Link), TRICARE, and/or CHAMPUS:
    • for the five years of employment immediately preceding your retirement; or,
    • during all of your federal employment since your first opportunity to enroll (if employed or eligible less than five years).

    If your annuity effective date is on the first of the month, this transition will occur immediately.  If your annuity effective date is not the first of a month, your DC Health Link coverage will continue to the end of the month and the OPM-contracted FEHB plan of your choice will begin the first of the next month.  You will continue receiving a government contribution in retirement.  For more information, please contact your agency’s benefits officer.

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  • Members of Congress will determine which of their staff members work in the official office.  Members may delegate this responsibility to the House or Senate Administrative Offices.  Those staff members that are designated as working in the official office must choose health plans from the DC Health Link.
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