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Frequently Asked Questions Insurance

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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