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Insurance FAQs

General

  • A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees.  OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.   
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  • No, MSP options are not generally more expensive than other plans on the Marketplace.  However, the prices for all options on the Marketplace may vary depending on whether they are bronze, silver, or gold level plans.
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  • Insurers selected to offer coverage through the Multi-State Plan Program must be licensed in each State and are subject to all requirements of State law, except those that would prevent the application of provisions of the Affordable Care Act. OPM may set additional requirements for participating insurers in consultation with HHS.
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  • OPM negotiates terms of coverage with each Multi-State Plan issuer, including medical-loss ratio, profit margin, premiums and provider networks. OPM may prohibit issuers from offering MSP options on the Marketplace that fail to meet these terms and conditions. 
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  • The Affordable Care Act requires OPM to contract with insurance companies to offer Multi-State Plan (MSP) options in every State and the District of Columbia.  OPM brings significant experience to this task, having administered the Federal Employees Health Benefits (FEHB) Program for more than 50 years.  The FEHB Program contracts with health insurance companies to offer a wide variety of FEHB coverage options to over 8 million Federal employees, annuitants, and family members across the country.  Consumers that purchase MSP coverage will benefit from OPM’s experience with contract negotiation and oversight of insurers. 
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  • The Multi-State Plan (MSP) Program is a program created by the Affordable Care Act and implemented by OPM. OPM evaluates insurance plans submitted by private insurers and certifies plans as Multi-State Plan options for sale in the Health Insurance Marketplace. These plans will eventually be available to consumers in all States and the District of Columbia, after a phase-in period. OPM will monitor the plans’ performance in the market and oversee their compliance with the law, as well as the requirements of the plans’ contracts with OPM. MSP coverage became available in the Marketplace in January 2014.
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  • The Program was given this title through its authorizing language in the Affordable Care Act. The name reflects the fact that OPM contracts with insurers in multiple States. At this time, “multi-State” does not necessarily mean you can use your plan to get in-network benefits in multiple States. While the authorizing language does not require Multi-State Plan options to provide nationwide coverage, a number of the plans offer a nationwide network, and OPM anticipates this number will increase as the Program evolves.  
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  • Some Multi-State Plan options offer in-network care outside of your service area, but not all.  If you live in one State and work, go to college, or spend a lot of time in another State, carefully check the provider directories of the plans you’re considering buying.  See if their networks have doctors, hospitals, and other healthcare providers in the places you’ll be.  Also, check out the plan’s payment policies for out-of-network care.
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  • No; however, there may be another Multi-State Plan (MSP) option available to you in the new State. To see what States have MSP options, visit http://www.opm.gov/healthcare-insurance/multi-state-plan-program/consumer/.
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  • CO-OP plans must adhere to all of the requirements for qualified health plans set forth by the Affordable Care Act. CO-OPs are different from other insurers in that they are consumer- governed, non-profit health plans. All surplus revenue must be used to lower premiums, enhance benefits, or improve quality of care for consumers.
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  • No.  Federal employees are eligible for the Federal Employees Health Benefits (FEHB) Program. The Affordable Care Act requires OPM to maintain separation between the FEHB Program and the MSP Program; however, both programs benefit from the customer service and oversight that OPM provides.
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  • As required by the Affordable Care Act, MSP insurers in each State must offer at least one plan that does not include elective abortion services. In 2015, most MSP insurers do not offer an MSP option that covers elective abortion. In many of these States, insurers offering non-MSP choices on the Health Insurance Marketplace are offering plans that cover elective abortions.  
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  • Two insurers currently participate in the Multi-State Plan Program. OPM contracts with the Blue Cross and Blue Shield Association, on behalf of its state-level issuers, and a group of Consumer Operated and Oriented Plans (CO-OPs) to offer MSP coverage in a total of 36 States, including the District of Columbia. In 2015, there are over 200 MSP options at the bronze, silver, and gold levels. Click here to view a map that provides State-level information on plan availability.   
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  • Multi-State Plan options are offered, along with other approved plans, on the Health Insurance Marketplace. The Marketplace is a one-stop shop where you can compare prices on health plans, buy coverage, and obtain Federal subsidies if you qualify for them. The next open enrollment period for Marketplace coverage begins November 15, 2014. Individuals and small business owners can enroll directly through the online Marketplace portal  (HealthCare.gov or CuidadodeSalud.gov), or call 1-800-318-2596, a toll-free hotline available 24 hours a day, 7 days a week to enroll. Neutral in-person assisters and Navigators are available to guide you through the Marketplace application. Please visit localhelp.healthcare.gov to find an assister in your area. 
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  • The Multi-State Plan Program External Review Process is unique because OPM administers the process directly. OPM will review whether your insurance company’s denial was justified by examining the terms of coverage and the specific circumstances surrounding the denial. If medical expertise is needed for review of a denial, an Independent Review Organization (IRO) will provide a decision. In most cases, OPM or an IRO will reach a decision within 30 days. If you are denied emergency services or if your doctor has determined that the denial of care would seriously jeopardize your life or jeopardize your ability to regain maximum function, you may be able to request expedited External Review without first exhausting your insurance company's appeal process. In that case, OPM or the IRO generally will make a decision within 72 hours. 
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  • CO-OP stands for Consumer Operated and Oriented Plan. A CO-OP is a new type of nonprofit health insurer that is directed by its customers and is designed to offer individuals and small businesses affordable, customer-friendly, and high-quality health insurance options. CO-OPs may operate locally, statewide, or in multiple States. CO-OPs must be licensed as issuers in each State in which they operate and are subject to State laws and regulations that apply to all similarly-situated issuers. Source:  http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/coop_final_rule.html 
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  • External review is the process by which OPM, or an Independent Review Organization if the case requires medical judgment, reviews a health insurance plan’s decision to deny a benefit or payment for a service for an enrollee in an MSP option. Except in certain circumstances, you must first file an internal appeal with the health plan to reconsider its decision. If the plan continues to deny the benefit or payment, you have the right to request an external review.  Please visit the Multi-State Plan Program External Review website for more information.
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  • Please visit the Multi-State Plan Program External Review website for detailed instructions on how to file a request for external review, including a list of documents you will need. You may file the request yourself or submit an Authorized Representative Form to appoint a representative to handle the request on your behalf.  You may call OPM toll free at (855) 318-0714 if you need help with your request for External Review.
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  • The purpose of the Multi-State Plan (MSP) Advisory Board is broadly outlined in section 1334(h) of the Affordable Care Act, which states that the Board shall “provide recommendations on the activities described in this section.” The Board will serve in an advisory capacity as a forum for interactive dialogue and exchange of ideas between consumers, consumer representatives, other stakeholders, and OPM staff. The output of Board meetings should serve to better inform OPM’s policy development, rulemaking, and outreach activities with regard to the MSP Program.
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  • An application to serve on the Multi-State Plan Program Advisory Board is located here. Each Board member will be appointed by the Director or his/her designee and serve a two-year term, although members may serve additional terms, if appointed by the Director or his/her designee. Board members will serve without payment from OPM but will be compensated for travel expenses, including transportation and per diem expenses, as authorized by Federal travel regulations.
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