District of Columbia Employees Health Benefits Program

District of Columbia Employees Health Benefits (DCEHB) Program

If you were hired by the District of Columbia Government in a benefits-eligible position on or after October 1, 1987, and you retired under the optional, voluntary, mandatory, or involuntary options, you are eligible to continue your health insurance coverage with the District of Columbia Employees Health Benefits (DCEHB) Program, provided you had 10 consecutive years of service with the District and you contributed to the health insurance program for 5 consecutive years immediately preceding the effective date of your retirement. 

If you retired due to a disabling condition with at least five creditable years of service, you are eligible to continue your District of Columbia-sponsored health insurance coverage as well. 

Access the Other Post-Employment Benefits Application Form Here

Please refer to the Frequently Asked Questions immediately below for helpful information about enrolling or making changes to your Plan. If you have any additional questions, don't hesitate to contact DCRB Member Services or call the Member Services Center at 202-343-3272.

What health insurance coverage is available to me? 

The District of Columbia currently offers four different Health Care Providers. These include:

• Aetna Healthcare HMO, PPO or CDHP;
• Kaiser Permanente HMO;
• United Healthcare Choice Nationwide HMO and PPO
• CareFirst BlueCross BlueChoice HMO, PPO, or CDHP

If you are age 65 and over, you may be eligible to select one of the Medicare Advantage plans offered by the District of Columbia Employees’ Health Benefits Program. Medicare Advantage, also known as “Medicare Part C,” is offered by a private company that contracts with Medicare to provide a beneficiary with Part A and Part B Medicare. The retiree must still pay the Part B premium.

Only current retirees who currently participate in a DC Employee Health Benefits plan and have Medicare Part A and Part B. Each enrollee must be Medicare-eligible. If a dependent is not Medicare eligible, the retiree may not enroll in a Medicare Advantage plan and must stay in a current non-Medicare plan. For example, If the retiree has a dependent who is not Medicare eligible, the retiree may not enroll in a Medicare Advantage plan if they wish to insure their dependent. 

The carriers offering a Medicare Advantage plan through the District of Columbia Employees Health Benefits Program include Aetna, CareFirst (Blue Cross Blue Shield), Kaiser Permanente, and United Healthcare. Select the carriers below for more information about each plan, including its enrollment form and summary of benefits.

• Aetna Medicare Advantage
  • Aetna Medicare Advantage Summary of Benefits
  • Aetna Medicare Advantage Enrollment Form
• CareFirst (Blue Cross Blue Shield) Medicare Advantage
  • CareFirst (Blue Cross Blue Shield) Medicare Advantage Summary of Benefits
  • CareFirst (Blue Cross Blue Shield) Medicare Advantage Enrollment Form
• Kaiser Permanente Medicare Advantage
  • Kaiser Permanente Medicare Advantage Summary of Benefits
  • Kaiser Permanente Medicare Advantage Enrollment Form
• United Healthcare Medicare Advantage
  • United Healthcare Medicare Advantage Summary of Benefits
  • United Healthcare Medicare Advantage Enrollment Form

Are My Family Members Covered?

Yes, your eligible family members may be enrolled in your DCEHB coverage. 

Do I Need to Submit Proof of My Family Member’s Eligibility?

Yes, the District of Columbia Employees’ Health Benefits program requires DCRB to periodically confirm the continued eligibility for dependents enrolled in the plan. If you add family members to your coverage, you are required to provide documentation to verify coverage eligibility for the dependents that you add during the Open Enrollment process or following a qualifying life event. When you enroll online, you must also submit dependent eligibility verification. Failure to comply will result in a cancelation of health care coverage for that dependent.

Do not send original documents or the actual certified copy with a raised seal. A copy of the document with the seal clearly visible is acceptable. Retain the original document(s). We will not return the documents you submit. Each piece of documentation must have the employee’s name and the last four digits of their Social Security number. DCHR has the authority to determine whether the documentation satisfies the plan’s requirements. Any fees associated with obtaining documents are the employee’s responsibility.

You must enroll during Open Enrollment or within 60 days of a qualifying life event.

Note: You are not required to provide annual verification for dependents currently covered by any DC Government health plan; however, the DC Government reserves the right to request supporting documentation at any time.
 
Covering Your Spouse

Provide a copy of one of the following:

• Most recent year’s 1040 Married Filing Jointly federal tax return that lists the spouse (black out financial information and dependents’ Social Security numbers)
• Subscriber’s and spouse’s most recent 1040 Married Filing Separately federal tax return (black out financial information and dependents’ Social Security numbers)
• Proof of common residence (example: a utility bill) and marriage certificate*
• Proof of financial interdependency (example: a shared bank statement. Black out financial information) and marriage certificate*
• Petition for dissolution of marriage (divorce)
• Legal separation notice

 
Covering Your State-Registered Domestic Partner or Legal Union Partner

Provide a copy of one of the following:

• Proof of common residence (example: a utility bill) and certificate/card of state-registered domestic partnership*
• Proof of financial interdependency (example: a shared bank statement; black out financial information) and certificate/card of state-registered domestic partnership*
• Petition for invalidity (annulment) of domestic partnership or legal union
• Petition for dissolution of domestic partnership or legal union
• Legal separation notice of domestic partnership or legal union

Learn more about Domestic Partner Health Benefits, including eligibility, tax provisions, and documentation.
 
Covering Your Child(ren)

Provide a copy of one of the following:

• Most recent year’s federal tax return that includes the child(ren) as a dependent and listed as a son or daughter (black out financial information and dependents’ Social Security numbers)
• Birth certificate (or hospital certificate with the child’s footprints on it) showing the name of the parent who is the subscriber, the subscriber’s spouse, or the subscriber’s state-registered domestic partner**)
• Certificate or decree of adoption
• Court-ordered parenting plan
• National Medical Support Notice
• Original Foster child certification and a copy of documentation of regular and substantial support of the child***
• Disabled Child: Medical verification of disability prior to age 26
• Legal Custody: Copy of Court Order granting legal custody
• Step Child: Birth Certificate**, Copy of Marriage Certificate, Divorce Decree or Custody Papers

You can submit one copy of your tax return if it includes all family members that require verification.

*If within two years of marriage or state-registered domestic partnership, then only the marriage certificate or certificate/card of state-registered domestic partnership is required.
**If the dependent is the subscriber’s stepchild, the subscriber must also verify the spouse or state-registered domestic partner to enroll the child, even if not enrolling the spouse/partner in DCEHB and DCEHB coverage.
***More than one of the following proofs may be required to show support of a recognized natural child who does not live with the enrollee in a regular parent-child relationship and for whom a judicial determination of support has not been obtained: Evidence of eligibility as a dependent child for benefits under other State or Federal programs; Proof of inclusion of the child as a dependent on the enrollee’s income tax returns; Canceled checks, money orders, or receipts for periodic payments from the enrollee for or on behalf of the child; Evidence of goods or services that show regular and substantial contributions of considerable value.

What Do I Have to Do?

You must submit acceptable proof of eligibility for each family member within 30 days of the open enrollment closing date, or they will automatically be removed from coverage.

What Happens If I Refuse to Send the Documentation?

If you do not provide the required documentation, your family members will be deemed ineligible and removed from coverage.

Ineligible Enrollment Consequences

The District of Columbia Employee Health Benefits Program has strict rules to ensure the integrity and fairness of the system. Here are some key points: 

• False Statements and Misrepresentation: Any intentionally false statement or willful misrepresentation, such as including ineligible family members on your health insurance plan, is considered a violation of the law. This can result in penalties, including fines up to $10,000, imprisonment for up to 5 years, or both. 
• Investigations: Violations may be subject to investigation, and individuals found guilty may face legal consequences.
• Eligibility: Only eligible dependents can be included in the health insurance plan.  Providing false information about dependents can lead to serious repercussions.
• Penalties: The penalties for such violations are designed to deter fraudulent activities and ensure that the benefits are provided only to those who are rightfully entitled to them.

When and How Can I Make Changes to My Coverage?

You can make changes to your coverage during the annual District of Columbia Annual Benefits Open Season (mid-November through mid-December) or following a qualifying life event. During this time, you can change plans, options, or the type of enrollment (Self Only, Self Plus One, or Self and Family). 

How Can I Learn More About My Options?

The plan sponsor, the District of Columbia Human Resources (DCHR), provides additional information on each of the plans mentioned. Before making your final enrollment decision, be sure to review the individual DCEHB brochures, as each brochure serves as the official statement of benefits for that plan.

I have coverage with a non-DCEHB carrier. Can I cancel my DCEHB plan? 

Yes, you can cancel your coverage either during the open enrollment season or within 30 days of obtaining coverage outside of the DCEHB program. However, please note that if you cancel your coverage, you will not be able to re-enroll in the program.