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Roll Call

Open Enrollment: The Top 10 Things to Consider

Open enrollment season for members of Congress and designated staff started quietly Monday, coinciding with a federal holiday and Capitol Hill’s first three-day weekend since the shutdown.

Because a visit to DC Health Link was likely a low priority amid the parades, wreath-laying ceremonies and other Veterans Day commemorations, Roll Call has compiled a list of must-know info for people looking to buy insurance under the Affordable Care Act:

1. No More FEHBP for Some

All congressional staffers designated as employees of a member’s “official office” will be terminated from coverage under the Federal Employees Health Benefits Program on Dec. 31. During 2014, these staffers are eligible only for employer-provided coverage plans available through DC Health Link. As long the member continues to employ the staffer, that designation remains in effect. Members will reassess the designations on an annual basis. For 2015, designations must be completed by Sept. 30, 2014. For new hires, coverage begins the first of the month following the date of the new hire.

2. All Choices Are Gold Plans

While there are three tiers of plans — bronze, silver and gold — offered through the exchanges set up under the health care law, members and staff will select from an assortment of 112 higher-end “gold” plans, offered through the District’s Small Business Health Option Program (DC SHOP), according to the Office of Personnel Management. The four carriers offering plans to Congress are CareFirst Blue Cross Blue Shield, Kaiser, Aetna and United Healthcare. Open enrollment season for all those plans ends Dec. 9. That’s the “absolute deadline,” according to DC Health Link officials. The system will not accept any late enrollments, but those being terminated from the FEHBP are subject to a 31-day coverage extension.

3. Calculate Your Contribution

DC Health Link directs users to a calculator to estimate monthly premium costs, based on age. For families, the total is based on the age of the employee, age of spouse, plus the ages of the three oldest children under 21. For those with more than three children under 21, all will be covered but only three count toward the overall cost of the premium. The employer contribution is 75 percent of your plan’s premium, up to a dollar cap that the OPM determines annually. For 2014, the maximum monthly contribution is $426.14 per individual and $948.18 per family. Insurance will still be considered a pre-tax expenditure.

4. Buying Other Coverage Comes With Catches

Nothing in the OPM’s final rule limits an individual from purchasing insurance through other methods outside the exchanges. But designated staffers who don’t purchase insurance through DC SHOP would forfeit the government contribution and their eligibility for employer-provided health insurance upon retirement. They would also forfeit the pre-tax payroll deduction and need to make their own arrangements for paying a premium.

5. And So Does FEHBP Coverage

Congressional staffers who still have employer coverage through the FEHBP can enter the exchange market, but they won’t receive a government contribution. Designated staffers with a husband or wife who is still FEHBP-eligible can join their spouse’s plan during the open enrollment season.

6. Outside D.C.? Look Carefully

Employees purchasing insurance through DC SHOP who don’t reside in the Washington area will need to make sure that they purchase one of the 56 plans with a national provider network, rather than one of the 56 focused on the District region. CareFirst, for instance, is offering a number of plans that use the same national provider database as the standard and basic federal employee benefits plans offered through Blue Cross Blue Shield. Doctors should be able to tell patients whether they can accept plans in the exchange. The DC Health Link site also has a list of providers with links to their websites.

7. Watch for Higher Deductibles

Many congressional staffers joining the exchanges will need to be aware of some changes that could affect their personal budgets, since the plan that CareFirst is referring to as its “featured plan” in promotional documents provided to congressional aides has significantly higher deductibles but comparable or lower out-of-pocket maximums. For instance, the in-network family deductible for the standard Blue Cross federal employee benefits plan has a $700 family deductible, as compared to a $2,000 deductible for the featured offering on DC SHOP. On the other hand, some benefits are more substantial in the DC SHOP plan once you reach the deductible. For instance, there are no out-of-pocket costs after the deductible for X-rays and other lab services with the exchange offering CareFirst is promoting.

8. Keep Your Dental and Vision Coverage

Designated staffers who like their vision and dental coverage through federal benefits programs can keep it. They are still eligible to enroll in, cancel or make a change to coverage under the Federal Employees’ Dental and Vision Program during the open enrollment period. The deadline is the same — Dec. 9.

9. FEHBP Returns With Retirement

Members and designated staff will be eligible to return to the FEHBP upon qualifying for retirement. To qualify for employer-provided health insurance during retirement, the OPM requires enrollment or coverage under DC Health Link, the FEHBP or both for five years preceding retirement.

10. Info Sessions Can Help

The House chief administrative officer tried to address some unanswered questions during a staff briefing on Nov. 7, which is now available to watch online. Senate staffers will get a similar presentation on Nov. 19, according to a Senate aide. Representatives from the House CAO’s Office of Payroll and Benefits and the four carriers will host daily open houses in Longworth Room 1310 through Friday. The Senate’s health fair is on Dec. 3, according to the aide. Official details have not yet been released.

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