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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

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