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Frequently Asked Questions Insurance

Multi State Plan Program

  • 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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  • 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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  • 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. Individuals can enroll directly through the online Marketplace portal (HealthCare.gov or CuidadodeSalud.gov ), or call 1-800-318-2596 to enroll.


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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. 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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  • 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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  • OPM has held meetings and phone calls with stakeholders to seek input, as well as address questions and concerns.  OPM has also conducted presentations at national meetings and conferences and held office hours to obtain feedback from interested parties. 
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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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