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Multi-State Plan Program and the
Health Insurance Marketplace Consumer

 

Overview

STOP

If you are enrolled in a Federal Employees Health Benefits (FEHB) plan, you should not be enrolled in, or covered by, a Multi-State Plan (MSP Option).

A Multi-State Plan (MSP) option is a high-quality plan offered on the Marketplace, under contract with the U.S. Office of Personnel Management (OPM), the agency that also administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act (ACA).

  • We have an External Review process to allow you to appeal to OPM if your claims are denied.
  • MSP options are required to cover Essential Health Benefits, which include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
  • OPM has been trusted for 50 years by millions of Federal employees, retirees, and their families to provide high quality FEHB health insurance

For the 2018 plan year, MSP options will be offered throughout the State of Arkansas by Arkansas Blue Cross Blue Shield. Visit HealthCare.gov or CuidadoDeSalud.gov to learn more about the Marketplace. Open enrollment starts November 1, 2017 and ends December 15, 2017, with coverage beginning January 1, 2018.

Related Information

FAQs

STOP

If you are enrolled in a Federal Employees Health Benefits (FEHB) plan, you should not be enrolled in, or covered by, a Multi-State Plan (MSP Option).

  • Why should I choose a Multi-State Plan? View more
    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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  • What benefits are required in Multi-State Plan coverage? View more
    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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  • How can I find out if a particular provider is in a Multi-State Plan network? View more
    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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  • If I enroll my family in a Multi-State Plan option, can my children be covered if they go to college out of State? View more
    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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  • How does OPM select Multi-State Plan insurers? View more
    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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  • Are enrollees in Multi-State Plan options eligible for subsidies? View more
    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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  • Are Multi-State Plan insurers required to comply with all State laws? View more
    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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  • Who offers Multi-State Plan options on the Marketplace? How many plans are available? View more
    In 2018, Arkansas Blue Cross and Blue Shield will offer three Multi-State Plan options on the Marketplace.
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  • If I sign up for a Multi-State Plan option and then need to get care in a different State, can I get in-network benefits in that State? View more
    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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  • What is external review? View more
    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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  • What makes the Multi-State Plan Program External Review Process unique? View more
    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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  • I have Multi-State Plan coverage, and I would like to file a request for external review. What are my next steps? View more
    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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  • How do I enroll in Multi-State Plan coverage? View more
    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. Individuals can enroll directly through the online Marketplace portal (HealthCare.gov or CuidadodeSalud.gov ), or call 1-800-318-2596 to enroll.
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  • What is the Multi-State Plan Program? View more
    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. 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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  • Do Multi-State Plan (MSP) options cover elective abortion services? View more
    OPM requires each MSP issuer to offer at least one silver MSP option and one gold MSP option that excludes coverage of elective abortion services (i.e., abortion services for which Federal funding is prohibited) in every service area of every State in which it offers MSP coverage.  Currently, no MSP options cover elective abortion services.
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  • Is State licensure required for insurers participating in the Multi-State Plan Program? View more
    Insurers selected to offer coverage through the Multi-State Plan Program must be licensed 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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  • How has OPM been soliciting feedback from interested parties with a stake in the Multi-State Plan Program? View more
    OPM has held meetings and phone calls with stakeholders to seek input, as well as address questions and concerns.  OPM has also conducted presentations at national meetings and conferences and held office hours to obtain feedback from interested parties. 
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  • How does OPM work with States on reviewing policy forms and benefits for Multi-State Plan insurers? View more
    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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  • Can members of the public attend Multi-State Plan Program Advisory Board meetings? View more
    Each Board meeting will be open to the public, to the extent that a facility is available to accommodate the public.  OPM may also close a portion of any meeting to the public for confidential discussion.  Meeting dates will be posted on the OPM website.  For more information, please email mspp@opm.gov.
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