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Insurance FAQs

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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  • 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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  • 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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  • In 2018, Arkansas Blue Cross and Blue Shield will offer three Multi-State Plan options on the Marketplace.
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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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