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QLEs include, but are not limited to:
- Marriage;
- Birth or adoption of child; and
- Loss of other coverage. Examples include:
- You were covered under your parents’ coverage and are no longer eligible due to turning 26.
- You, or a family member, were covered under another employer’s plan and are losing eligibility for the other employer’s health plan.
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A newly elected Member of Congress or newly hired designated congressional staff has 30 days to enroll in a DC Health Link plan starting on the later of date of hire or the date their eligibility for DC Health Link is entered by the administrative office to the DC Health Link system (usually 1-3 days after hire). The coverage will be effective on the 1st day of the month following the date of hire. For example, if a Member of Congress or designated congressional staff is hired or entered on April 17, the individual will have until May 16 to enroll. If that person enrolls on May 15, the coverage will be effective retroactively to May 1.
This 30-day rule applies for new hires at any time. For example, if an employee is hired during open season, that person will still have 30 days from the date of hire to enroll, even if open season ends before the 30-day enrollment period ends.
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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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No. DC Health Link rules allow you to select which of your eligible family members you would like to cover. Remember that the only eligible family members under FEHB rules are spouses and children under age 26 (including legally adopted children, recognized natural children, stepchildren and foster children who meet certain requirements) and children age 26 or over who are incapable of self-support because of a physical or mental disability that existed before the child reached age 26. Note: If you have a court or administrative order to provide coverage for a child, you must include that child in your DC Health Link plan or be able to prove that you have purchased other coverage for him or her.
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Yes. Your FEHB or DC Health Link health coverage with the House of Representatives as your employer will terminate at the end of the month in which your employment terminates. You will need to enroll in a DC Health Link plan with the Senate as your employer in order to continue/begin coverage under DC Health Link. You should be conscious of gaps in coverage and inquire of your losing employer on your TCC needs/rights.
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If you separate from federal service, your DC Health Link coverage will terminate and you will need to buy coverage through a new employer, the individual Marketplace, or elsewhere. You would also be eligible for Temporary Continuation of Coverage (TCC) provided by an OPM-contracted FEHB carrier.
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If your plan is no longer offered in the next coverage year, you can choose to enroll in a different plan during the Open Enrollment. If you do not enroll in a different plan during Open Enrollment, DC Health Link will automatically enroll you in the plan available with the most similar coverage to your plan, as determined by the insurance company in which you are enrolled.
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Generally, yes. After a break in service of four days or more, you will be treated as a new employee. Your new employing Member of Congress will need to designate you as either “official office” staff or not. Your previous enrollment in a health benefits plan will be terminated and you will need to reenroll. However, OPM has determined that if you are reemployed by the same Member of Congress, the annual designation made by that Member will take precedence and your prior designation will not be affected. (In this case, you will still need to reenroll in a DC Health Link plan to have continued coverage.)
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Yes. Your FEHB or DC Health Link health coverage with the House of Representatives as your employer will terminate at the end of the month in which your employment terminates. You will need to enroll in a DC Health Link plan with the Senate as your employer in order to continue/begin coverage under DC Health Link. You should be conscious of gaps in coverage and inquire of your losing employer on your TCC needs/rights.
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The open enrollment period for Members of Congress and designated staff enrolling in DC Health Link will be the same as the FEHB Open Season, which runs from mid-November until mid-December each year. In addition, Members of Congress and designated congressional staff will be allowed to enroll or make enrollment changes upon being hired or within 30 days upon experiencing a Qualifying Life Event (QLE).
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Once open enrollment begins, you can sign up for coverage at
www.DCHealthLink.com. If you are a new hire, you may enroll within 30 days of the date you are notified by your administrative office that you have been entered in the DC Health Link system.
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After the end of the 31-day extension of your FEHB plan coverage, you will no longer have health insurance with a Government contribution. Failing to enroll in a SHOP health plan will also result in a break in coverage that may preclude you from being able to enroll in a FEHB-contracted plan at the time of retirement. You may be able to enroll after Open Enrollment if you experience a Qualifying Life Event. Please contact your administrative office for more information.
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For coverage effective January 1 of the next plan year, you will need to sign up for a DC Health Link health plan during Open Enrollment.
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