Draft_MSPP_Application_Appendix_A_Section_II_MSP_Information.xlsx
XLSX spreadsheet 14 KB Posted
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- Multi-State Plan Program Application
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- OPM35-12-R-0006
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Draft MSPP Application Appendix A Section II
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MSP Information
| State | MSP Product / plan name | Associated HIOS Product ID | Planned Exchange market (Individual or Small Group) | Proposed coverage levels (Platinum, Gold, Silver, Bronze, Catastrophic) | Proposed product type (HMO, PPO, POS, Indemnity, EPO) | New or existing product/plan? If existing, complete "Appeals" worksheet for this product/plan. | Essential Health Benefits benchmark plan | Primary care provider designation required? | Specialist referrals required (in-network and out-of-network)? | State-required benefits (list) | Product / plan filed with State? | URL for Summary of Benefits and Coverage (SBC) | SBC reviewed by State? | HSA eligible? | Accreditation status for this product/plan | Accrediting entity | Is accreditation based on national, regional, or local set of policies and procedures? | Product's annual enrollment for last 5 years (if small group market, number of groups and number of enrollees) | Product's disenrollment rate for last 5 years | URL for provider directory |
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&"+,Bold"&13&K04+000Appendix A: MSP Information
&"+,Bold"&K04+000MSPP Draft Application
File details come from the government source that posted it. Updated .