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Insurance FAQs

Issuer-specific

  • 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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  • 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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