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U.S. Office of Personnel Management

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Insurance FAQs Health

SHOP Eligibility & Enrollment

What happens if I am a Member of Congress or designated congressional staff and I do not sign up for a SHOP health plan by December 9, 2013? View more

After the end of the 31-day extension of your FEHB plan coverage (i.e. after January 31, 2014), 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 an OPM-contracted plan at the time of retirement.
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I am a congressional employee designated to purchase coverage on the Exchanges and currently enrolled in a health benefits plan via the DC SHOP. Will I need to be re-designated if I terminate employment in a congressional office and am reemployed in another congressional office after a break of four days or more? View more

Yes. After a break in service of four days or more, you will be treated as a new employee. Your new position will need to be evaluated and the Member of Congress for whom you work will need to designate you as either “official office” staff or not “official office” staff. 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, within the same calendar year, the annual designation made by that Member will remain in effect and you will maintain the same eligibility for DC SHOP enrollment.
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Will eligible former spouses of Members of Congress and designated congressional staff enroll for coverage under the DC SHOP or via an OPM-contracted FEHB Plan? View more

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, please see the OPM Former Spouse webpage and the Former Spouse section in the FEHB Handbook.
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I am a Member of Congress or congressional staff enrolled via the DC SHOP. I plan on separating from service later in the year. Does my enrollment last the whole year or can I cancel when I switch jobs? View more

Because coverage under the DC SHOP is employer-sponsored coverage, your plan coverage will terminate when you leave your job. You may be eligible for Temporary Continuation of Coverage via an OPM-contracted FEHB plan. Please contact your benefits officer for more information and view the OPM Losing & Ineligible for FEHB webpage.
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I am a Member of Congress or designated congressional staff. Do I need to purchase coverage for all of my eligible family members under my DC SHOP enrollment? View more

No. DC SHOP rules allow for you to select which of your eligible family members you would like to cover. Remember that only spouses, and children under age 26 (including legally adopted children, recognized natural children, stepchildren and foster children who meet certain requirements) are eligible family members under FEHB rules. Note: If you have a court or administrative order to provide coverage for a child, you must include that child in your DC SHOP plan or be able to prove that you have purchased other coverage for him or her.
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