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Insurance FAQs

Workers' Compensation and FEGLI

  • I'm receiving benefits from the Department of Labor, Office of Workers' Compensation Programs (OWCP). Do I still have life insurance? View more
    To continue life insurance benefits as an OWCP compensationer, you must have carried FEGLI for the 5 years of service immediately before the beginning date of compensation or, if you had it less than 5 years, for the full period(s) of service during which you were eligible to be insured. This coverage is subject to the same conditions as those of a civil service retiree. Please see your human resources office if you are receiving compensation benefits.
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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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  • 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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  • 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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  • 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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