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Insurance FAQs

Multi State Plan Program

  • What is a multi-state plan? View more
    Multi-state Plans are health insurance plans that are available in states through health insurance exchange in 2014. There are to be at least two in every state and at least one of these health plans must be a non-profit organization.
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  • Is state Licensure required for insurers in the multi-state plan? View more
    The insurers selected to be in the multi-state plan must be licensed in each State and are subject to all requirements of state law, except those that would prevent the application of provisions of the Act. OPM may set additional requirements for participating insurers in consultation with HHS.
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  • Would the enrollees in the plan be eligible for subsidies? View more
    An enrollee in a multi-state plan would be eligible for the income-based premium subsidy and cost-sharing subsidy. However, the subsidies do not to reflect the costs of any state benefit mandate above the essential benefit package; in that case the state must pay the corresponding amount to either the individual or the multi-state plan.
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  • How will OPM negotiate the terms of coverage with each multi-state plan? View more
    The OPM will negotiate terms of coverage with each multi-state plan, including medical-loss ratio, profit margin and premiums, and may prohibit MSPs that fail to meet these terms and conditions from participating in the state exchanges.
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  • How does an Insurer qualify as a multi-state qualified health plan? View more
    • Offer the essential health benefits package
    • Be uniform in each state – although a state can require that additional benefits be offered to enrollees in that state (in which case the State assumes the financial liability for costs of mandates);
    • Meet the qualified health plan requirements including offering the various actuarial levels of coverage
    • Determine premiums using the rating rules under the Act unless the State has age rating rules less than 3:1  and
    • Meet requirements applicable to the Federal Employees Health Benefit Program that do not conflict with the Act.
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  • How do I enroll in a multi-state plan? View more
    The Multi-State Plans will begin in 2014 and will be a one stop shop for individuals and small business owners to compare prices on health plans, buy coverage and obtain federal subsidies.
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  • Will an MSPP issuer be required to be licensed in each State that they offer an MSP? View more
    Section 1334(b)(2) of the Affordable Care Act directs that an MSPP issuer be licensed in each State where it offers an MSP. OPM proposes to clarify that, during each year of the phase-in period, an MSPP issuer need only be licensed in the States where it is offering coverage during that year, and not necessarily in all States.
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  • How does OPM intend to work with States on form filing and review for MSPP issuers? View more
    MSPs will be subject to Federal and State laws with respect to benefit plan material or information, including requirements at proposed 45 C.F.R. § 800.113. Although OPM intends to review and approve policy forms for health insurance coverage, OPM expects MSPP issuers to comply with related State law requirements for policy form review. OPM expects that that few disagreements will arise between OPM and a State regarding policy form review and, if they do, that we will be successful in resolving them in a manner that is acceptable both to OPM and the State at issue. OPM intends to work closely with each State in reviewing forms for the MSPs in that State and will consult with that State as appropriate to ensure that the MSPs are not disruptive to markets.
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  • Will stand-alone dental plan issuers be able to participate in the MSPP in 2014? View more
    OPM will not be soliciting applications for stand-alone dental plans for participation in the MSPP for the 2014 benefit year.
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  • How is OPM soliciting feedback from relevant stakeholders, such as Tribes? View more
    OPM solicited feedback on the MSPP from stakeholders by issuing a Request for Information (RFI) on June 16, 2011. In addition to the RFI, OPM has held meetings and phone calls with stakeholders to seek input and guidance while drafting the notice of proposed rulemaking (NPRM). OPM also published a draft issuer application on Federal Business Opportunities website on September 20, 2012 and solicited comments from the public. The draft application, Solicitation Number: OPM35-12-R-0006, can be viewed on the Federal Business Opportunities website available at MSPP Draft Application. We are reviewing those comments and will issue a final application soon. In addition, OPM leadership has met with staff from the National Indian Health Board and National Council of Urban Indian Health to solicit feedback from Tribes. OPM is also leveraging existing relationships with Tribes by coordinating with staff that handles coverage of Tribal employees in the Federal Employees Health Benefit Program. OPM will also coordinate with HHS in its communication with Tribal Leaders on the Affordable Care Act.
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  • What are the network adequacy standards proposed by OPM for the MSPP? View more
    An MSPP issuer must ensure that the provider network of each of its MSPs, as available to all enrollees, meets the following standards: • is sufficient in number and types of providers to ensure that all services will be accessible to enrollees without unreasonable delay; • is consistent with the network adequacy provisions of section 2702(c) of the Public Health Service Act; and • includes essential community providers in compliance with 45 C.F.R. § 156.235. In addition, an MSPP issuer must make its provider directory for each MSP available to the Exchange for publication online pursuant to guidance from the Exchange and to potential enrollees in hard copy upon request. In the provider directory, an MSPP issuer must identify providers that are not accepting new patients. OPM will issue guidance containing the criteria and standards that it will use to determine the adequacy of a provider network. A draft MSPP application was published September 20, 2012 on Federal Business Opportunities website. OPM accepted comments on the draft MSPP application through October 22, 2012 and is carefully reviewing comments submitted. In this draft application, OPM proposed specific standards for network adequacy. The draft application, Solicitation Number: OPM35-12-R-0006, can be viewed on the Federal Business Opportunities website available at MSPP Draft Application. OPM will publish the final MSPP application in early 2013.
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  • Will MSPs and MSPP issuers be required to comply with all State laws? View more
    The Affordable Care Act generally requires that MSPs and MSPP issuers comply with all State and Federal laws that apply to QHPs and QHP issuers. However, the Affordable Care Act also grants discretion to the Director to administer the MSPP in a manner that fulfills OPM’s statutory responsibility under section 1334 of the Affordable Care Act. OPM intends to administer the MSPP in a manner that achieves the objectives of the law. It is not possible at this time to identify with specificity the laws that will apply to QHPs and QHP issuers. Therefore, it is not possible to identify any law that OPM deems to be inconsistent with section 1334 of the Affordable Care Act, our proposed regulations, OPM guidance, or OPM’s contracts with MSPP issuers.
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  • Are multi-state plans available in every state? View more
    While the multi-state plan provision is intended to create nationwide coverage, the insurers are allowed to phase in the coverage, with coverage in 60% of the states in year one, 70% in year two, 85% in year three, and 100% in year four and each subsequent year.
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Total Count: 13, Number of Pages: 0, Page: 1

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