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Multi-State Plan Program and the
Health Insurance Marketplace Consumer

 

Overview

Note:

If you are enrolled in FEHB coverage, you don’t need a Marketplace plan to meet Affordable Care Act coverage standards.

Why Should I Choose MSP Coverage?

Multi-State Plan (MSP) coverage is high-quality health insurance backed by the experience of OPM, the agency trusted by millions of Federal employees, retirees, and their families to provide their health insurance.

  • We work with our insurance partners to ensure you receive the coverage you signed up for.
  • If your claims are ever denied, we are here to help you appeal.
  • You have peace of mind knowing that OPM has over 50 years of experience running the Federal Employee Health Benefits Program.
  • We are committed to bringing you high quality health insurance.
  • While some MSP options provide portable coverage or the ability to get in-network care out of state, not all do. Please check your plan’s out-of-network payment policies and provider directory carefully.

Pick a State or use the drop-down menu to view options for the 2017 plan year..

MSP Coverage No MSP Coverage

To choose a Multi-State Plan option that’s right for you, go to HealthCare.gov.

FAQs

Note:

If you are enrolled in FEHB coverage, you don’t need a Marketplace plan to meet Affordable Care Act coverage standards.

  • As required by the Affordable Care Act, MSP insurers in each State must offer at least one plan that does not include elective abortion services. In 2015, most MSP insurers do not offer an MSP option that covers elective abortion. In many of these States, insurers offering non-MSP choices on the Health Insurance Marketplace are offering plans that cover elective abortions.  
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  • Two insurers currently participate in the Multi-State Plan Program. OPM contracts with the Blue Cross and Blue Shield Association, on behalf of its state-level issuers, and a group of Consumer Operated and Oriented Plans (CO-OPs) to offer MSP coverage in a total of 36 States, including the District of Columbia. In 2015, there are over 200 MSP options at the bronze, silver, and gold levels. Click here to view a map that provides State-level information on plan availability.   
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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. The next open enrollment period for Marketplace coverage begins November 15, 2014. Individuals and small business owners can enroll directly through the online Marketplace portal  (HealthCare.gov or CuidadodeSalud.gov), or call 1-800-318-2596, a toll-free hotline available 24 hours a day, 7 days a week to enroll. Neutral in-person assisters and Navigators are available to guide you through the Marketplace application. Please visit localhelp.healthcare.gov to find an assister in your area. 
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  • CO-OP stands for Consumer Operated and Oriented Plan. A CO-OP is a new type of nonprofit health insurer that is directed by its customers and is designed to offer individuals and small businesses affordable, customer-friendly, and high-quality health insurance options. CO-OPs may operate locally, statewide, or in multiple States. CO-OPs must be licensed as issuers in each State in which they operate and are subject to State laws and regulations that apply to all similarly-situated issuers. Source:  http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/coop_final_rule.html 
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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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  • The Multi-State Plan (MSP) Board serves as a forum for dialogue and exchange of ideas between consumers, consumer representatives, other stakeholders, and OPM staff. The output of Board meetings will serve to better inform OPM’s policy development, rulemaking, and outreach activities with regard to the MSP Program.
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  • The Advisory Board consists of Multi-State Plan Program enrollees, enrollee representatives, public health and/or healthcare professionals (including providers and Navigators/assistors) and representatives of other stakeholder groups. Health insurers or representatives of insurers are not considered for Board membership.  For a list of the 2015-2016 Board members, click here.
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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: 30, Number of Pages: 2, Page: 2

Fact Sheet

The U.S. Office of Personnel Management (OPM) has entered into a contract with the Blue Cross and Blue Shield Association and New Mexico Health Connections, a Consumer Operated and Oriented Plan (CO-OP), to offer 203 Multi-State Plan (MSP) options in 22 States on the Health Insurance Marketplace. The plans will be overseen by OPM, which brings more than 50 years of experience running the Federal Employees Health Benefits Program to the MSP Program.

The Affordable Care Act created the MSP Program to drive competition. MSP options ensure that Americans across the country have access to high-quality health insurance plans with reliable benefits. OPM ensures that these plans have an effective network of providers, a high percent of spending on health care rather than administrative costs, and strong consumer protections.

MSP options are available through the Health Insurance Marketplace on HealthCare.gov or CuidadoDeSalud.gov, the Spanish version of the site. The Marketplace provides one-stop shopping, where consumers can see health insurance options in one place and find out if they’re eligible for financial assistance.

Open enrollment starts November 1, 2016 and ends January 31, 2017, with coverage beginning as early as January 1, 2017.

Visit HealthCare.gov or CuidadoDeSalud.gov to learn more about the Health Insurance Marketplace. For more information on the Multi-State Plan Program, visit the MSP Program page.

Advisory Board

Background

Section 1334(h) of the Affordable Care Act, authorizes the Director of OPM to “establish an advisory board to provide recommendations on the activities” of the Multi-State Plan (MSP) Program and a “significant percentage of the members of such board shall be comprised of enrollees in a multi-State qualified health plan, or representatives of such enrollees.” The purpose of the MSP Program Advisory Board (“Advisory Board”) is to exchange information, ideas, and recommendations regarding OPM’s administration of the MSP Program, including plan design, branding and marketing, network adequacy, and other topics. Advisory Board meetings will serve as a forum for interactive dialogue and exchange of individual experiences and viewpoints among consumers, consumer representatives, and OPM staff. This forum will serve to better inform OPM’s policy development, rulemaking, and outreach activities with regard to the MSP Program.

MSP Program Advisory Board Members

OPM is proud to announce the members of its new MSP Program Advisory Board:

  • Fadesola Adetosoye, MS, Dell, Inc.
  • Randall Brown, MPA, National Aeronautics and Space Administration (NASA)
  • Darryl Burton, MS, MBA, Centers for Medicare & Medicaid Services (CMS), San Francisco Regional Office
  • Davekumar Chandrasekaran (“Dave Chandra”)
  • Cheryl Fish-Parcham, MSW, FamiliesUSA
  • Ken Hall, International Brotherhood of Teamsters
  • Arcelia Hinojosa, Righttime Medical Care
  • Heather Howard, JD, Princeton University
  • Robin Lavender, DuPage County Health Department
  • Sara Lipton-Lubet, JD, National Partnership for Women & Families
  • Chanda McNeal, MPA, Center for Consumer Information & Insurance Oversight, CMS
  • Michael Minor, A.B., Ed.D., National Faith-Based Mobilization Network
  • Chad Moore, JD, MHA, Children's Mercy Hospital
  • Stephen Patrick, MD, MPH, MS, Vanderbilt University
  • Kaye Pestaina, JD, Mercer
  • Stephen Petzinger, Office of Management and Budget (OMB)
  • Gail Post, MA, Group facilitator and counselor
  • Aaron Smith, JD, YI Advisors
  • Michelle Trotter, MPH, BSN, Howard County General Hospital
  • Will “Bear” Velazquez, Federal Aviation Administration

The first Board meeting was held on Thursday, July 30, 2015, in Washington, DC. The Second Board meeting will be held on Thursday, March 10, 2016, in Washington, DC.

Control Panel