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8. Members of Congress and their designated staff were dropped from the overall FEHBP. "Section 1312 of the Affordable
Sun Dec 14, 2025, 04:49 PM
Sunday

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 purchase a health benefits plan on the Small Business Health Options Program (SHOP). 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 in order to receive a government contribution."

"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 and for Self and Family enrollments, respectively, or (2) 75 percent of the total premium for the particular plan an enrollee selects."

Source: https://www.opm.gov/healthcare-insurance/changes-in-health-coverage/eligibility-enrollment/#url=Members-of-CongressStaff


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