MSPP_Application_01_2013.pdf

PDF 763 KB Posted Jan 18, 2013

Attached to: Multi-State Plan Program Application
Solicitation number: OPM35-12-R-0006
Issued by: Office of Personnel Management Healthcare and Insurance Division

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MSPP Application

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Financial_Rating_Template.xlsx	XLSX spreadsheet	Jan 18, 2013
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DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan

Program. Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request additional information from applicants.

U.S. Office of Personnel Management

Multi-State Plan Program Application

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request additional information from applicants.

APPLICANT INFORMATION

Contracting Entity

Contracting entity legal name:

Street Address:

City, State, ZIP code:

NAIC Company Code (Optional):

Contact Information

Name:

Title:

Phone:

Email Address:

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

Contents

APPLICANT INFORMATION

Glossary

Application questions

Section 1: Applicant

Applicant overview and phase-in information

Applicant information

Group of Issuers

Managerial capabilities

Financial solvency

Oversight, control, and consolidation of functions

Essential Health Benefits Benchmark Plan

Section 2: State-level MSP Issuer information

Administrative information

Enrollment experience

Financial

Accreditation status

Claims

Member services

Marketing

Utilization/quality assurance

IT Systems, security and confidentiality

Provider contracts

Enrollment

Disaster recovery/Business continuity

Prescription Drugs

Service area

Provider network

Standards applicable to QHP issuers

Section 3: Product information

Benefit proposal

Rate proposal

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

Glossary

Applicant An issuer or Group of Issuers that has submitted an application to OPM to be considered for participation in the Multi-State Plan Program

Group of Issuers (1) a group of health insurance issuers who are affiliated either by common ownership and control or by common use of a nationally licensed service mark or

(2) an affiliation of health insurance issuers and an entity that is not an issuer but that owns a nationally licensed service mark.

Health Insurance Oversight System

(HIOS)

The Health Insurance Oversight System (HIOS) allows the government to collect data from states/territories as well as individual and small group market issuers.

The collected data is aggregated with other data sources and made public on a consumer-facing website. HIOS is operated by The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Department of Health and Human Services (HHS).

Multi-State Plan

(MSP)

A health plan that is offered under a contract with OPM pursuant to section 1334 of the Affordable Care Act

Multi-State Plan Program Issuer (MSPP Issuer)

A health insurance issuer or group of issuers that has a contract with OPM to offer health plans pursuant to section 1334 of the Affordable Care Act.

Nationally licensed service mark

A word, name, symbol, or device, or any combination thereof, that an issuer or group of issuers uses consistently nationwide to identify itself.

State-level MSP Issuer

A health insurance issuer designated by the Applicant to offer MSPs on the Applicant’s behalf. The State-level MSP Issuer may offer coverage in all or part of one or more states.

Application questions

Section 1: Applicant

Applicant overview and phase-in information

1.1.Q1 Provide an introductory overview of your organization. Explain how your organization’s participation as an MSPP Issuer would benefit the MSPP. For example, what solutions, efficiencies, economies of scale, or unique approaches do you propose to bring to the MSPP and Exchanges?

Text box (6000 character maximum)

1.1.Q2 Does the Applicant currently contract with OPM for the Federal Employees Health Benefits

Program (FEHBP)?

○ Yes ○ No

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.1.Q3 Indicate the States in which you propose to enter the Individual Market as a MSPP Issuer in Year

1, Year 2, Year 3, and Year 4 of your participation [INTERACTIVE MAP].

1.1.Q4 For states you have selected for Year 1, indicate whether you also propose to participate in the SHOP market

Applicant information

1.2.Q1 Describe your corporate structure and management.

1.2.Q2 [Not required of current FEHB carriers] Provide documentation of your corporate structure. This may include executed articles of incorporation or organization, partnership agreement(s), or any other applicable organization documents.

1.2.Q3 Describe the legal and organizational relationship between the Applicant and the State-level MSP

Issuers that will provide health insurance under this contract.

Choose States for Year 1

Choose States for Year 2

Choose States for Year 3

Choose States for Year 4 http://www.google.com/imgres?q=UPLOAD+BUTTON&start=204&um=1&hl=en&safe=active&biw=1082&bih=995&tbm=isch&tbnid=L_AQx0VKOfdCiM:&imgrefurl=http://depositphotos.com/3913351/stock-illustration-Single-Circle-upload-button.html&docid=DGhQKQvo-oWsLM&imgurl=http://static4.depositphotos.com/1000993/391/v/450/dep_3913351-Single-Circle-upload-button.jpg&w=450&h=450&ei=VHUNUN35MaPd0QHO9LyEBA&zoom=1&iact=hc&vpx=123&vpy=634&dur=140&hovh=225&hovw=225&tx=105&ty=129&sig=100934346186872591764&page=8&tbnh=154&tbnw=155&ndsp=30&ved=1t:429,r:25,s:204,i:183 http://www.google.com/imgres?q=UPLOAD+BUTTON&start=204&um=1&hl=en&safe=active&biw=1082&bih=995&tbm=isch&tbnid=L_AQx0VKOfdCiM:&imgrefurl=http://depositphotos.com/3913351/stock-illustration-Single-Circle-upload-button.html&docid=DGhQKQvo-oWsLM&imgurl=http://static4.depositphotos.com/1000993/391/v/450/dep_3913351-Single-Circle-upload-button.jpg&w=450&h=450&ei=VHUNUN35MaPd0QHO9LyEBA&zoom=1&iact=hc&vpx=123&vpy=634&dur=140&hovh=225&hovw=225&tx=105&ty=129&sig=100934346186872591764&page=8&tbnh=154&tbnw=155&ndsp=30&ved=1t:429,r:25,s:204,i:183

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.2.Q4 Describe how the Applicant interacts with the State-level MSP Issuers, including decision-making processes and lines of authority. How will the Applicant ensure that the State-level MSP Issuers comply with the terms of the MSPP contract?

1.2.Q5 [Not required of current FEHB carriers] Describe the Applicant’s history of health insurance operations, including reorganizations, mergers, changes of ownership, and name changes that have taken place within the last 10 years.

1.2.Q6 Is the Applicant a non-profit entity?

1.2.Q6.1 If a non-profit entity, provide documentation.

1.2.Q7 [Not required of current FEHB carriers] Is the Applicant owned by, affiliated with, or sponsored by another organization that provides management and/or financial support to the Applicant?

○ Yes ○ No

1.2.Q7.1 [Not required of current FEHB carriers] If Yes, provide details including legal relationship, administrative, management, financial or other services the other organization provides. In what ways, if any, is the other organization financially responsible for the Applicant?

1.2.Q8 [Not required of current FEHB carriers] Describe any significant legal actions or ongoing investigations that may impact the Applicant’s financial stability or operational abilities.

1.2.Q9 Has the Applicant and/or any of its State-level MSP Issuers been sanctioned or penalized by conviction, civil judgment, or otherwise, for engaging in fraudulent, criminal, or other improper activity in any government program?

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.2.Q9.1 If yes to Q9, provide details.

1.2.Q10 Provide a signed opinion by legal counsel that the Applicant and State-level MSP Issuers are not debarred, suspended, or ineligible to participate in Federal Government contracting for any reason, including fraudulent health care practices in other Federal health care programs. This includes members of the board of directors, any key management or executive staff, major stockholders, affiliated companies, subsidiaries, subcontractors, and subcontractor staff.

Group of Issuers

1.3.Q1 Are you a Group of Issuers?

○ Yes ○ No

1.3.Q1.1 If yes to Q1, describe the managerial organization, control and decision-making structures for the group.

1.3.Q1.2 If yes to Q1, describe any contractual, agency, fiduciary or other relationship between affiliated issuers that will ensure that the Applicant complies with the terms of its MSPP contract.

1.3.Q1.3 If yes to Q1, describe how conflicts between affiliated issuers are resolved.

1.3.Q1.4 [Not required of current FEHB carriers] If applicable, provide a copy of the contract or other documents relating to the use and ownership of the service mark.

Managerial capabilities

1.4 Provide the names, titles, and resumes (or summary of relevant experience) of key personnel at the

Applicant level that would be assigned to this contract in the following critical areas:

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.4.Q1 Chief Executive Officer

First Name:

Last Name:

Employee Title:

Phone:

Email:

Resume:

Percent of time dedicated to MSPP:

1.4.Q2 Contracting Official

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q3 Overall management/OPM Contact

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q4 Enrollment

First Name:

Last Name:

Employee Title:

Phone:

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DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.4.Q5 Claims

Last Name:

Employee Title:

Phone:

1.4.Q6 Claims disputes

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q7 Customer Service

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q8 Financial management

First Name:

Last Name:

Employee Title:

Phone:

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.4.Q9 Actuarial analysis

Last Name:

Employee Title:

Phone:

1.4.Q10 Care management

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q11 IT systems

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q12 Compliance

First Name:

Last Name:

Employee Title:

Phone:

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.4.Q13 Medical director

Last Name:

Employee Title:

Phone:

1.4.Q14 Quality

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q15 State-level MSP Issuer Liaison/Oversight/Coordination

First Name:

Last Name:

Employee Title:

Phone:

1.4.Q16 Other

First Name:

Last Name:

Employee Title:

Phone:

DISCLAIMER: This final application represents policies included in proposed regulations for the Multi-State Plan Program.

Accordingly, the U.S. Office of Personnel Management reserves the right to modify this application, as necessary, and to request

1.4.Q17 Provide a chart of the Applicant’s entire organizational structure, highlighting which parts of that structure would be involved in managing the MSPP contract. Identify where the key personnel listed above reside in the organizational structure.

Financial solvency

1.5.Q1 Describe any fiduciary, agency, or trust relationship that exists between the Applicant and the

State-level MSP Issuers.

1.5.Q2 Specify the actions that the Applicant would take if a State-level MSP Issuer becomes insolvent.

1.5.Q3 If a State-level MSP Issuer becomes unable to fulfill its responsibilities under an MSPP contract, how will the Applicant guarantee contract performance in that State, including full payment of claims?

1.5.Q4…

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 14, 2017.