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    Frequently Asked Questions Insurance

    Multi State Plan Program

    • 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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    • A Multi-State Plan insurer must offer a benefits package that is uniform within each State and includes “essential health benefits” in the following categories:

      1.Ambulatory patient services
      2.Emergency services
      3.Hospitalization
      4.Maternity and newborn care
      5.Mental health and substance use disorder services, including behavioral health treatment
      6.Prescription drugs
      7.Rehabilitative and habilitative services and devices
      8.Laboratory services
      9.Preventive and wellness services and chronic disease management
      10.Pediatric services, including oral and vision care

      A Multi-State Plan insurer must also offer any additional benefits required under its State’s laws.

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    • A Multi-State Plan (MSP) insurer must make its provider directory for each MSP option available to the Marketplace for publication online and to you in hard copy if you ask for it.  In the provider directory, an MSP insurer must identify providers that are not accepting new patients. 
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    • You will want to review the benefits covered by any plan you are considering to see if your children’s out-of-State providers are included in the plan’s network.  Services provided by health care providers outside of a plan’s network typically cost more than services delivered by in-network providers.
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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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    • In 2018, Arkansas Blue Cross and Blue Shield will offer three Multi-State Plan options on the Marketplace.
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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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    • 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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