Multi-State health plans offered in most states limit coverage for abortions to what is considered therapeutic or non-excepted abortions. Abortions will only be covered under the Multi-State Plans (MSP) in the cases of harm to the mother’s health or conception as a result of rape or incest. Elective abortions are not a covered benefit under MSPs.
Multi-State Plans administered by OPA
Multi-State Plans were authorized by the Affordable Care Act and are administered by the federal government’s U.S. Office of Personnel Management (OPA). Health insurance companies must submit their health plan design to the OPA for approval. One of OPA’s goals is to approve health plans in all 50 states that have uniformity in their coverage benefits under the MSP program.
December 16, 2015: Kaiser Health News – Despite Hopes Of Health Law Advocates, ‘Multi-State’ Health Plans Unavailable In Many States
From the FAQs page of the OPAs MSPs
- A Multi-State Plan option is a high-quality plan offered on the Marketplace, under contract with OPM, the agency that administers health insurance for Federal employees. OPM negotiates plan benefits, monitors plan performance, and oversees plan compliance with the Affordable Care Act, so you can be assured of consistent, quality coverage.
- A Multi-State Plan insurer must offer a benefits package that is uniform within each State and includes “essential health benefits”
- As a general rule, Multi-State Plan (MSP) insurers have to comply with applicable State laws. The Affordable Care Act reserves the possibility that certain exceptions to State law may become necessary for appropriate OPM oversight of the program.
- Insurers selected to offer coverage through the Multi-State Plan Program 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 Affordable Care Act. OPM may set additional requirements for participating insurers in consultation with HHS.
- The Multi-State Plan (MSP) Program is a program created by the Affordable Care Act and implemented by OPM. OPM evaluates insurance plans submitted by private insurers and certifies plans as Multi-State Plan options for sale in the Health Insurance Marketplace. These plans will eventually be available to consumers in all States and the District of Columbia, after a phase-in period.
- The Program was given this title through its authorizing language in the Affordable Care Act. The name reflects the fact that OPM contracts with insurers in multiple States. At this time, “multi-State” does not necessarily mean you can use your plan to get in-network benefits in multiple States.
- As required by the Affordable Care Act, MSP insurers in each State must offer at least one plan that does not include elective abortion services. In 2015, most MSP insurers do not offer an MSP option that covers elective abortion. In many of these States, insurers offering non-MSP choices on the Health Insurance Marketplace are offering plans that cover elective abortions.
Anthem Blue Cross Multi-State Plans in California
In California Anthem Blue Cross offers MSPs. They are almost identical to their other Qualified Health Plans offered through Covered California and off-exchange with the exception of the abortion limitation. From the Anthem Blue Cross Silver Multi-State Plan Evidence of Coverage-
Benefits include services for abortion that will only be provided if the pregnancy is the result of an act of rape or incest or in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed. – pg 88, ABC MSP Silver, 2014
Elective abortion coverage
A health plan that does not limit coverage for abortion will have language similar to Blue Shield of California Evidence of Coverage for their PPO plans –
Family Planning Benefits
Benefits are provided for the following family planning services without illness or injury being present:
1) family planning, counseling and consultation services, including Physician office visits for office-administered covered contraceptives;
2) vasectomy; and
3) elective abortions. –pg 17, BSC EOC PPO, 2014
ABC correction notices
Both the name and the coverage benefits can be confusing. Anthem Blue Cross had to send out a correction letter to renewing members of MSPs because the elective abortion language was included in the new 2015 summary of benefits.
Thank you for choosing Anthem Blue Cross for your health care coverage. We’re writing to tell you about an error in the benefit comparison chart for your 2015 plan. The chart stated that “Abortions will no longer be limited to Therapeutic Abortion.” This statement is not correct. Your new plan is required to keep this limitation. This means the correct statement is as follows: “Abortions will be limited to Therapeutic Abortion.”
Confusion in California
Covered California had been peppered with enough questions as to what a MSP was and the abortion limitations that they included clarification in their a sales seminar held on December 3, 2014
Only Silver and Gold PPO and EPO MSPs will be available from Anthem Blue Cross for 2015.
Selecting your level of choice
If you don’t want a health plan that provides coverage for elective abortions, then the MSP is for you. If you don’t want any limitation on family planning coverage, then select a plan that covers elective abortions. Either way, you should always consult the Evidence of Coverage or Member Agreement to see exactly how the health plan covers abortion services.