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Healthcare & Insurance Multi-State Plan Program and the
Health Insurance Marketplace

 

Overview

STOP

If you are enrolled in a Federal Employees Health Benefits (FEHB) plan, you should not be enrolled in, or covered by, a Multi-State Plan (MSP Option).

A Multi-State Plan (MSP) option is a high-quality plan offered on the Marketplace, under contract with the U.S. Office of Personnel Management (OPM), the agency that also administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act (ACA).

  • We have an External Review process to allow you to appeal to OPM if your claims are denied.
  • MSP options are required to cover Essential Health Benefits, which include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
  • OPM has been trusted for 50 years by millions of Federal employees, retirees, and their families to provide high quality FEHB health insurance

For the 2018 plan year, MSP options will be offered throughout the State of Arkansas by Arkansas Blue Cross Blue Shield. Visit HealthCare.gov or CuidadoDeSalud.gov to learn more about the Marketplace. Open enrollment starts November 1, 2017 and ends December 15, 2017, with coverage beginning January 1, 2018.

FAQs

STOP

If you are enrolled in a Federal Employees Health Benefits (FEHB) plan, you should not be enrolled in, or covered by, a Multi-State Plan (MSP Option).

  • 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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  • 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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  • 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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  • Each Board meeting will be open to the public, to the extent that a facility is available to accommodate the public.  OPM may also close a portion of any meeting to the public for confidential discussion.  Meeting dates will be posted on the OPM website.  For more information, please email mspp@opm.gov.
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Total Count: 18, Number of Pages: 2, Page: 2
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