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Monday, December 2, 2013

Health Benefits for Members of Congress and Certain Congressional Staff

Annie L. Mach
Analyst in Health Care Financing

Ada S. Cornell
Information Research Specialist

The federal government, as an employer, offers health benefits to its employees, including Members of Congress and congressional staff. Traditionally, Members and staff have had access to many of the same health benefits as other federal employees. For example, Members and staff have been eligible to voluntarily enroll in employer-sponsored health insurance through the Federal Employees Health Benefits Program (FEHBP), and they can choose to participate in other health benefit programs, such as the Federal Flexible Spending Account Program (FSAFEDS).

Section 1312(d)(3)(D) of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) generally specifies that the only health plans that the federal government may make available to Members and certain congressional staff (with respect to their service as Members or staff) are either created under ACA or offered through an exchange. A final rule issued by the Office of Personnel Management (OPM) amends FEHBP eligibility regulations to comply with Section 1312(d)(3)(D) of ACA. Under the final rule, beginning January 1, 2014, Members and designated congressional staff will no longer be able to purchase FEHBP plans as active employees; however, if they enroll in a health plan offered through a small business health options program (SHOP) exchange, they will remain eligible for an employer contribution toward coverage. Additionally, the final rule allows Members and designated congressional staff who are eligible for retirement to enroll in a FEHBP plan upon retirement.

This report summarizes the provisions of the final rule and describes how it affects current and retired Members and congressional staff. OPM has indicated that Members and congressional staff will be eligible for other health benefits related to federal employment, and these additional health benefits are outlined in this report. These health benefits include FSAFEDS, the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal Long Term Care Insurance Program (FLTCIP), the Office of the Attending Physician, and treatment in military facilities. This report also discusses Members’ and staff’s eligibility for Medicare, which does not appear to be affected by the final rule.

For information about the health benefits received by other federal employees (i.e., those who are not affected by the aforementioned final rule), see CRS Report RS21974, Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options, by Annie L. Mach.

Date of Report: November 4, 2013
Number of Pages: 15
Order Number: R43194
Price: $29.95

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