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Multi-State Plan Program and the
Health Insurance Marketplace Consumer

 

Overview

Note:

If you are enrolled in FEHB coverage, you don’t need a Marketplace plan to meet Affordable Care Act coverage standards.

Why Should I Choose MSP Coverage?

Multi-State Plan (MSP) coverage is high-quality health insurance backed by the experience of OPM, the agency trusted by millions of Federal employees, retirees, and their families to provide their health insurance.

  • We emphasize wellness and preventive care.
  • We make sure major benefit categories and services are covered.
  • We work with our insurance partners to ensure you receive the coverage you signed up for.
  • If your claims are ever denied, we are here to help you appeal.
  • You have peace of mind knowing that OPM has over 50 years of experience running the Federal Employee Health Benefits Program.
  • We are committed to bringing you better health through higher quality and lower cost care.

Pick a State or use the drop-down menu to view plan options.

MSP Coverage No MSP Coverage

FAQs

  • 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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  • A Multi-State Plan insurer must offer a benefits package that is uniform within each State and includes “essential health benefits” in the following categories: 1.Ambulatory patient services 2.Emergency services 3.Hospitalization 4.Maternity and newborn care 5.Mental health and substance use disorder services, including behavioral health treatment 6.Prescription drugs 7.Rehabilitative and habilitative services and devices 8.Laboratory services 9.Preventive and wellness services and chronic disease management 10.Pediatric services, including oral and vision care A Multi-State Plan insurer must also offer any additional benefits required under its State’s laws.
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  • A Multi-State Plan (MSP) insurer must make its provider directory for each MSP option available to the Marketplace for publication online and to you in hard copy if you ask for it.  In the provider directory, an MSP insurer must identify providers that are not accepting new patients. 
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  • It depends.  While OPM is encouraging statewide coverage in the Multi-State Plan (MSP) Program, it is not required of MSP insurers at this time.  OPM is, however, requiring MSP insurers that offer partial coverage in a State to submit a plan for extending coverage throughout the State. 
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  • The Health Insurance 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 Marketplace’s open enrollment period begins October 1, 2013, and continues through March 31, 2014.  Multi-State Plan options are offered in 2014, along with other approved plans on the Marketplace.  Individuals and small business owners can enroll directly through a website (HealthCare.gov or CuidadodeSalud.gov), as well as call 1-800-318-2596, a toll-free hotline available 24 hours, 7 days a week.  You can also seek help from Navigators and other neutral assistance personnel who can walk you through the Marketplace application.
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  • OPM holds meetings and phone calls with stakeholders to seek input, as well as address questions and concerns.  OPM also conducts presentations at national meetings and conferences and holds office hours to obtain feedback from interested parties. 
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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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  • The Blue Cross and Blue Shield Association, on behalf of its local plans, offer Multi-State Plan options in 30 States and the District of Columbia.  There are over 150 MSP options at the bronze, silver, and gold levels.  Click here to go to a map that provides more information about what is available in specific States. 
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  • You will want to review the benefits covered by any plan you are considering to see if your children’s out-of-State providers are included in the plan’s network.  Services provided by health care providers outside of a plan’s network typically cost more than services delivered by in-network providers.
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  • No.  Federal employees are eligible for the Federal Employees Health Benefits Program.  Multi-State Plan options are offered through the Marketplace, which can be found through your State or by going to www.HealthCare.gov.  However, both programs are run by the U.S. Office of Personnel Management and subject to the good customer service and oversight OPM provides.
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  • In order to be approved to offer one or more Multi-State Plan options, an insurer, among other things, must—
    • meet requirements for qualified health plans under the Affordable Care Act;
    • offer a package of “essential health benefits”; and
    • determine premiums using the rating rules under the Affordable Care Act except that if the state has more protective age rating requirements, defer to the state age rating rules.
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  • When you get health insurance coverage in the Marketplace, you may be eligible for subsidies that can lower your monthly premiums.  This depends on your income and family size.  Enrollees in Multi-State Plan options may qualify for this financial assistance.
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  • As a general rule, Multi-State Plan (MSP) insurers have to comply with applicable State laws.  The Affordable Care Act reserves the possibility that certain exceptions to State law may become necessary for appropriate OPM oversight of the program.  
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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 2014, 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.  MSP issuers will have the flexibility to offer additional options in 2015, which might include elective abortion services.
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  • Although OPM reviews and approves MSP applications, OPM expects MSP insurers to comply with State law requirements relating to the review of policy forms and benefits.  OPM works closely with each State in reviewing MSP applications and consults with each State as appropriate to ensure that the MSP options are not disruptive to markets.
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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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  • The Affordable Care Act allows for a phased-in approach to MSP coverage; insurers must offer coverage in all fifty States and the District of Columbia by year four of their participation in the program. Click here for a map detailing which states currently offer MSP coverage.
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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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Fact Sheet

The U.S. Office of Personnel Management (OPM) has entered into a contract with the Blue Cross and Blue Shield Association to offer more than 150 Multi-State Plan (MSP) options in 30 States and the District of Columbia on the Health Insurance Marketplace. The plans will be overseen by OPM, which brings its more than 50 years’ experience running the Federal Employees Health Benefits (FEHB) Program to the MSP Program.

The Affordable Care Act created the MSP options to drive competition. MSP options ensure that Americans across the country have access to high-quality health insurance plans with reliable benefits. OPM ensures that these plans have a broad network of providers, high percent of spending on health care rather than administrative costs, and strong consumer protections. These plans may also provide families with members who live in different States the option of being enrolled in the same plan.

With the MSP Program in place, uninsured Americans will have even more options for affordable coverage that works for them. Multi-State plans are already helping to drive competition and expand the number of plan options in many States. The MSP Program ensures that consumers have choice of plans across the country. Without the MSP option, in three States (Alaska, New Hampshire, and West Virginia) there would be only one type of insurance plan for consumers to consider. Additionally, MSP options will be offered in 10 Federally-facilitated Marketplaces where there are 5 or fewer issuers offering qualified health plans.

The law directs MSP options to extend to all 50 States plus the District of Columbia within the next four years.

MSP options will be available through the Health Insurance Marketplace on HealthCare.gov or CuidadoDeSalud.gov, the Spanish version of the site, and the Marketplace will provide one-stop shopping, where consumers will be able to see health insurance options in one place and find out if they’re eligible for a break on the cost of coverage.

Visit HealthCare.gov or CuidadoDeSalud.gov to learn more about the Health Insurance Marketplace. For more information on the Multi-State Plan Program and the New Health Insurance Marketplace, you may visit the MSP Program page.

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