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Frequently Asked Questions Insurance

Multi State Plan Program

  • 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 2015, 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.  
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  • No.  Federal employees are eligible for the Federal Employees Health Benefits (FEHB) Program. The Affordable Care Act requires OPM to maintain separation between the FEHB Program and the MSP Program; however, both programs benefit from the customer service and oversight that OPM provides.
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  • Two insurers currently participate in the Multi-State Plan Program. OPM contracts with the Blue Cross and Blue Shield Association, on behalf of its state-level issuers, and a group of Consumer Operated and Oriented Plans (CO-OPs) to offer MSP coverage in a total of 36 States, including the District of Columbia. In 2015, there are over 200 MSP options at the bronze, silver, and gold levels. Click here to view a map that provides State-level information on plan availability.   
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  • 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. The next open enrollment period for Marketplace coverage begins November 15, 2014. Individuals and small business owners can enroll directly through the online Marketplace portal  (HealthCare.gov or CuidadodeSalud.gov), or call 1-800-318-2596, a toll-free hotline available 24 hours a day, 7 days a week to enroll. Neutral in-person assisters and Navigators are available to guide you through the Marketplace application. Please visit localhelp.healthcare.gov to find an assister in your area. 
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  • CO-OP stands for Consumer Operated and Oriented Plan. A CO-OP is a new type of nonprofit health insurer that is directed by its customers and is designed to offer individuals and small businesses affordable, customer-friendly, and high-quality health insurance options. CO-OPs may operate locally, statewide, or in multiple States. CO-OPs must be licensed as issuers in each State in which they operate and are subject to State laws and regulations that apply to all similarly-situated issuers. Source:  http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/coop_final_rule.html 
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  • 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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  • 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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  • 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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