Q. Will individuals who enroll in Exchange plans follow the eligibility and enrollment requirements of Exchanges or the FEHB program?
A. The individuals who enroll in Exchange plans will be subject to the same rules established for others on the Exchanges. For additional information, please see www.healthcare.gov
Q. Will individuals who enroll in Exchange plans follow the same claim dispute process as FEHB if they disagree with their Exchange plan’s decision about benefits coverage or the provision of a medical service?
A. No. There are separate external appeal provisions that apply to health plans participating on Exchanges. For information, please see www.healthcare.gov.
Q. Will Members of Congress and their staff be able to carry coverage purchased on the Exchange into retirement?
A. Yes. Members of Congress and their staff who purchase health insurance coverage on the Exchange will be eligible to carry that coverage, with the Government Contribution, into retirement; pursuant to the same eligibility requirement for FEHB enrollees (e.g. enrolled in a health insurance plan for five years prior to retirement or since their earliest opportunity to enroll). Members of Congress and their staff who retire with Exchange plan coverage are not eligible to switch to an FEHB plan from an Exchange plan for coverage in retirement.
Q. Will Members of Congress and congressional staff be able to enroll for health plan coverage as individuals or as members of a SHOP?
A. Initially, OPM expects that Members of Congress and congressional staff will enroll in the individual market on Exchanges. However, OPM plans to work with stakeholders to determine whether employing offices could purchase insurance in the SHOP.
Q. Where do Members of Congress and their official staff enroll on Exchanges?
A. The Exchanges are established for individuals to enroll for health insurance coverage in the place where they reside. For information, please see www.healthcare.gov.
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