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 enroll in an appropriate Small Business Health Options Program (SHOP) in order to receive a government contribution. 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.
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, Self Plus One, 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.
Premium Contribution Calculator
The total monthly premium is your contribution as well as your employer's contribution. Your employer provides an Agency Contribution based on your total premium amount. To calculate your share of the premium, use the calculator below.
Based on Premium of $0 (Self)
*These contribution amounts are estimates.