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How does an Insurer qualify as a multi-state qualified health plan?

  • Offer the essential health benefits package
  • Be uniform in each state – although a state can require that additional benefits be offered to enrollees in that state (in which case the State assumes the financial liability for costs of mandates);
  • Meet the qualified health plan requirements including offering the various actuarial levels of coverage
  • Determine premiums using the rating rules under the Act unless the State has age rating rules less than 3:1  and
  • Meet requirements applicable to the Federal Employees Health Benefit Program that do not conflict with the Act.

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