SHOP Health Coverage
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Temporary continuation of coverage (TCC) will be available to Members of Congress and designated congressional staff who leave their jobs, as well as eligible family members, with the same rules that apply to TCC for other Federal employees and eligible family members. TCC will only be offered through OPM-contracted plans. Please contact your employing office for more information.
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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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Yes. All plans offered by Aetna as well as the CareFirst Multi-State plan do not offer elective abortion services. Aetna plan provider networks are available in all states except Alaska, Iowa, Idaho, South Dakota, Wyoming, Montana, and Hawaii. The CareFirst Multi-State plan provider network is available in all 50 states and the U.S. Territories.
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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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In order to receive a government contribution towards your premium, you must select from among the Gold metal level plans available via the DC Health Link. The DC Health Link requires that employers offering employees a choice of multiple plans and issuers must limit those choices to all plans within a single metal level. Congress, following guidance from OPM regarding the actuarial value of FEHB benefits, will be allowing its employees to choose among Gold metal level plans, as those are most comparable to the OPM-contracted FEHB plans offered to other federal employees.
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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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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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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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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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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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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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Yes. The DC Health Benefit Exchange Authority will post a PDF of each SBC for plans available on the DC Health Link at
www.DCHealthLink.com. These SBCs will be posted prior to open enrollment, which begins in mid-November.
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Total Count: 17, Number of Pages: 2, Page: 1