Implementing Healthcare Reform

The Patient Protection and Affordable Care Act

Other Provisions
 

MULTI-STATE PLANS

Health Care Choice Compacts

Plans will be allowed to be offered in two or more States starting 1/1/16. States may enter into an agreement under which:

  • One or more Qualified Health Plans could be offered in the individual markets of each State entering into the compact. A plan would abide by the regulations of the State in which it was issued
  • The issuer of a plan would:
    • Continue to be subject to market conduct, unfair trade practices, network adequacy and consumer protection standards;
    • Be required to be licensed in each State in which if offers the plan under the compact; and
    • Clearly notify consumers that the plan may not be subject to the laws and regulations in which they reside

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Multi-State Plans Overseen by OPM

The Office of Personnel Management (OPM) is required to contract with health insurers to offer at least two multi-state qualified health plans (at least one non-profit) through exchanges in each State.

OPM is required to negotiate contracts in a manner similar to the manner in which it negotiates contracts for Federal Employees Health Benefits Program (FEHBP).

Multi-state plans are required to cover essential health benefits and meet all of the requirements of a qualified health plan. States may require multi-State plans to offer additional benefits, but must pay for the additional cost.

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(Please note: This document was produced by the Self-Insurance Institute of America to provide an overview of the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act. It does not cover every aspect of the legislation, and certain provisions of the law may change or be modified by additional rules and regulations. This document does not constitute legal or tax advice.)