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Frequently Asked Questions Insurance

Workers' Compensation and FEGLI

  • 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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  • 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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  • 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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