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    Frequently Asked Questions Insurance

    Issuer-specific

    • 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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    • 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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    • 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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    • 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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    • 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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