As a Federal employee, you are eligible to elect Federal Employee Health Benefits (FEHB) coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. All FEHB plans qualify as minimum essential coverage (MEC) and meet the Affordable Care Act's individual shared responsibility requirement for the covered individual. All FEHB health plans are eligible employer-sponsored plans. The health coverage of all the plans in the FEHB Program meets the Affordable Care Act’s minimum value standard for the benefits that each FEHB plan provides.

Newly eligible employees may enroll within 60 days of becoming eligible for the FEHB Program. During the annual Federal Benefits Open Season, anyone eligible to participate in the FEHB Program may enroll, change health plans or options, or cancel FEHB enrollment. You may enroll, change your enrollment type, or change plans outside of Open Season if you experience a qualifying life event such as a change in family or other insurance coverage status.

You can enroll using the Health Benefits Election Form (SF 2809) or through an agency self-service system such as Employee Express, MyPay, Employee Personal Page, or Employee Benefits Information System (EBIS). Please contact the Human Resources Office (HRO) of your agency for details.

If you are eligible to enroll in the FEHB Program but do not enroll or cancel FEHB enrollment, consequences of such actions include, but are not limited to, the following:

• If an employee dies, he/she will not have an FEHB Self Plus One or Self and Family enrollment for his/her survivors to continue, even if he/she is eligible for a survivor annuity.
• If an employee retires, he/she will not have an FEHB enrollment to continue into retirement. Also, to be eligible to continue FEHB coverage after retirement, a retiring employee must be enrolled or covered under the FEHB Program for the five years of service immediately before retirement, or, if less than five years, for all service since the first opportunity to enroll. An employee can count his/her coverage under TRICARE toward meeting this requirement. However, the employee must be enrolled in an FEHB health plan on the date of retirement to continue coverage.

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 under the ACA.

Children Turning Age 26

As a result of the Affordable Care Act , children of Federal enrollees are covered by their parent’s FEHB Self Plus One enrollment (if they are the designated covered family member) or Self and Family enrollment until their 26th birthday.

Once your child turns 26, he/she loses FEHB coverage. Your child's coverage continues at no cost for 31 days after the enrollment terminates.

Your child is eligible to (1) enroll in Temporary Continuation of Coverage (TCC); or (2) purchase health insurance through the Health Insurance Marketplace:

1. TCC: For more information about TCC, please view the OPM TCC webpages.
2. Health Insurance Marketplace (the Marketplace): If your child would like to purchase health insurance through the Marketplace, he/she should visit www.HealthCare.gov. This is a website provided by the U.S. Department of Health and Human Services that provides up-to-date information on the Marketplace.

Former Spouse

A former spouse loses coverage as a family member upon divorce, subject to a 31-day extension of coverage. However, under the Civil Service Retirement Spouse Equity Act of 1984 (Public Law 98-615), as amended, certain former spouses of Federal employees, former employees, and annuitants may qualify to enroll in a health benefits plan under the Federal Employees Health Benefits (FEHB) Program.

As a former spouse, you may be eligible to (1) enroll in FEHB under Spouse Equity provisions; (2) enroll in Temporary Continuation of Coverage (TCC); or (3) purchase health insurance through the Health Insurance Marketplace:

1. Spouse Equity: For more information about Spouse Equity, please see the OPM Former Spouse webpage and the Former Spouse section in the FEHB Handbook.
2. TCC: For more information about TCC, please view the OPM TCC webpages.
3. Health Insurance Marketplace (the Marketplace): If you would like to purchase health insurance through the Marketplace, you should visit www.HealthCare.gov. This is a website provided by the U.S. Department of Health and Human Services that provides up-to-date information on the Marketplace.

Former Employee

An employee’s enrollment terminates at midnight of the last day of the pay period in which he/she is separated from Federal service.

As a former employee, you are eligible to (1) enroll in Temporary Continuation of Coverage (TCC); or (2) purchase health insurance through the Health Insurance Marketplace:

1. TCC: For more information about TCC, please view the OPM TCC webpages.
2. Health Insurance Marketplace (the Marketplace): If you would like to purchase health insurance through the Marketplace, you should visit www.HealthCare.gov. This is a website provided by the U.S. Department of Health and Human Services that provides up-to-date information on the Marketplace.

Ineligible for FEHB

If you are ineligible for FEHB, you can purchase health insurance through the Health Insurance Marketplace (the Marketplace) at www.HealthCare.gov. This is a website provided by the U.S. Department of Health and Human Services that provides up-to-date information on the Marketplace.

If you are unsure about your FEHB eligibility, please contact your agency’s Human Resources Office.

Overview

OPM issued a final rule to clarify the eligibility of Members of Congress and designated congressional staff for health insurance coverage under the Federal Employees Health Benefits (FEHB) Program.  Section 1312 of the Affordable Care Act requires that Members of Congress and their official staff obtain coverage by health plans created under the Affordable Care Act or coverage offered via an Affordable Insurance Exchange (Exchange).

Members of Congress and designated congressional staff who are subject to §1312 of the Affordable Care Act must purchase a health benefits plan on the Small Business Health Options Program (SHOP).  SHOPs were established to administer group health benefits to employees of eligible businesses.  Given the location of Congress in Washington DC, OPM 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.

The formula for government contributions is the same formula used for other federal employees.  The government contribution will equal the lesser of: (1) 72 percent of amounts OPM determines are the program-wide weighted average of premiums in effect each year, for Self Only and for Self and Family enrollments, respectively, or (2) 75 percent of the total premium for the particular plan an enrollee selects.

The Open Enrollment period for coverage under DC Health Link will coincide with the annual Federal Benefits Open Enrollment Period.

Eligibility & Enrollment

If you are a congressional staff member, the Member of Congress for whom you work will designate your status as “official office” or not "official office”, which will determine your eligibility to purchase coverage via DC Health Link.  If you have questions about your eligibility or how to enroll in a health plan, please contact:

House of Representatives: The House of Representatives Office of Payroll and Benefits can be reached Monday-Friday from 8:30am-5:30pm EST at (202) 225-1435.  The House of Representatives Office of Members’ Services can be reached Monday-Friday from 8:30am-5:30pm EST at (202) 225-3644.

Senate: The Senate Disbursing Office can be reached Monday-Friday from 9:00am-5:30pm EST at (202) 224-1093.

Information about DC Health Link can be found at www.DCHealthLink.com.