What Is DC Health Link?

DC Health Link is a new online marketplace where you can shop for public and private health insurance, make side-by-side comparisons, and choose the insurance policy that best meets your needs and budget. DC Health Link will tell you if you are eligible for help paying your premiums and your cost-sharing expenses.  For more information, visit www.dchealthlink.com.

When Can I Shop for Health Insurance?

Individuals can shop during open enrollment season and throughout the year if they experience a life event such as a birth, death, marriage, new job, etc. Small businesses in the District may shop anytime throughout the year.

Who Can Shop for Health Insurance at DC Health Link?

You will be able to shop for insurance at DC Health Link if you are a legal U.S. resident and:

  • You are uninsured;
  • You buy your own health insurance;
  • You work for a small business that buys coverage through DC Health Link; or
  • You work part-time and don’t qualify for your employer’s benefits.

Will I Be Able to Get Help Shopping for Health Insurance?

DC Health Link’s trained experts will be available to you – at no cost – to help you apply, shop, and enroll. You can get help on the phone. You can get help online, too. Or you can work in-person with an expert who can walk you through all the steps.

What Insurance Companies are Participating?

Four insurers are participating in selling small group plan coverage:

  • Aetna
  • CareFirst
  • Kaiser Permanente
  • United Healthcare

Where Can I Call for Help With Insurance Matters?

The District has an Office of Health Care Ombudsman and Bill of Rights to counsel and provide assistance to people with matters pertaining to their health care coverage. You can reach this office by calling (202) 724-7491 or toll-free at 1(877) 685-6391 or by email at healthcareombudsman@dc.gov.For more information, visit hombudsman.dc.gov.

Is the District closing the commercial insurance market?

No, the District is not closing down the commercial insurance market. The Health Benefit Exchange (“HBX”) Executive Board adopted recommendations to unify commercial small group and individual plans within the District’s Exchange insurance marketplace. There are several reasons for the Board’s decision, including:

  • The District is a small jurisdiction both in terms of geography and demographics and needs economies of scale to support a robust and effective HBX;
  • This market structure provides a consistent consumer experience for all small business owners and individual purchasers;
  • Individuals, small business owners, agents and brokers (producers) have access to information on all health insurance plans available in the District in one, easy to navigate portal, and;
  • Individuals and small business employees are able to compare and select from a wider array of available health insurance plans.

What benefits will the District’s Health Benefit Exchange provide small businesses?

The District’s HBX provides transparency for selecting health coverage that does not currently exist by the creation of a single source to review price, quality, customer service information, and other consumer focused measures about all health plans available in the District.

Due to the selection of the largest small group plan currently available in the District as the benchmark for all health insurance plans sold in the market in 2014 (essential health benefits or EHB), small employers will be able to choose among plans virtually identical to those currently available.

The District’s HBX will expand the health coverage options available to small business owners and their employees. Employees are now able to select from a wider array of plans to best suit their needs without adding additional administrative costs or burdens on the employer.

What businesses will be able to participate in the District’s Health Benefit Exchange?

District of Columbia based small businesses with 1 to 50 employees are eligible to participate in the District’s Exchange insurance marketplace. As of July 1, 2016, small businesses in the District that purchase health insurance directly from an insurance company will now renew through DC Health Link. DC Health Link is working closely with the health insurance companies to coordinate the transition so it’s a smooth process for small employers, employees, and their Brokers.

Groups migrating onto DC Health Link will not have dental benefits setup as part of their benefit offerings on DC Health Link. These groups are able to add dental coverage as part of their benefit offerings on DC Health Link. If a migrating group has existing dental coverage, adding dental coverage on DC Health Link is not a renewal of this existing dental coverage, even if the group selects the same dental carrier and plan. Any groups that currently have dental coverage and add dental coverage as part of their benefit offerings on DC Health Link will need to contact their dental carrier to terminate their existing dental coverage.

Vision will continue to be handled directly with the carrier, outside of DC Health Link.

What tax credits are available for small business employers who cover their employees through the District’s Exchange?

The maximum credit is 50% for most employers and 35% for tax-exempt employers.

What are the penalties if a small business employer does not offer coverage to employees?

There are no penalties for not offering coverage to employees for small businesses with 50 or fewer employees.

How will small business owners select coverage for their employees through the District’s Exchange?

The ACA mandates that employers be allowed to select a “metal level” from which their employees can select any available plan. There will be four “metal levels” of plans available to small businesses in the HBX insurance marketplace. The metal levels are organized based on the portion of expected medical costs covered by the plan, otherwise referred to as “actuarial value” (AV). Bronze plans would have a 60% AV, silver plans a 70% AV, gold plans an 80% AV, and platinum plans a 90% AV.

Small business employers will have options for determining how to split premium costs between themselves and employers.