---
kind: "section"
citation: "42 U.S.C. § 18054"
title: "42"
title_heading: "The Public Health and Welfare"
number: "18054"
heading: "Multi-State plans"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/18054"
units:
  - "Chapter 157 — Quality, Affordable Health Care for All Americans"
  - "Subchapter III — Available Coverage Choices for All Americans"
  - "Part D — State Flexibility To Establish Alternative Programs"
---

# §18054. Multi-State plans

- (a) **Oversight by the Office of Personnel Management—**
  - (1) **In general—** The [Director](/usc/42/11851.md?p=5) of the Office of Personnel Management (referred to in this section as the “[Director](/usc/42/11851.md?p=5)”) shall enter into contracts with [health insurance issuers](/usc/42/18021.md?p=b-2) (which may include a group of [health insurance issuers](/usc/42/18021.md?p=b-2) affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to [section 6101 of title 41](/usc/41/6101.md) or other statutes requiring competitive bidding, to offer at least 2 multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) through each Exchange in each [State](/usc/42/18024.md?p=d). Such plans shall provide individual, or in the case of [small employers](/usc/42/18024.md?p=b-2), group coverage.
  - (2) **Terms—** Each contract entered into under [paragraph (1)](#a-1) shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. In entering into such contracts, the [Director](/usc/42/11851.md?p=5) shall ensure that health benefits coverage is provided in accordance with the types of coverage provided for under section 2701(a)(1)(A)(i) of the Public Health Service Act [[42 U.S.C. 300gg(a)(1)(A)(i)](/usc/42/300gg.md?p=a-1-A-i)].
  - (3) **Non-profit entities—** In entering into contracts under [paragraph (1)](#a-1), the [Director](/usc/42/11851.md?p=5) shall ensure that at least one contract is entered into with a non-profit entity.
  - (4) **Administration—** The [Director](/usc/42/11851.md?p=5) shall implement this subsection in a manner similar to the manner in which the [Director](/usc/42/11851.md?p=5) implements the contracting provisions with respect to carriers under the Federal employees health benefit program[^1] under [chapter 89](/usc/5/chptIII/sptG/ch89.md) of title 5, including (through negotiating with each multi-[state](/usc/42/18024.md?p=d)[^2] plan)—
    - (A) a medical loss ratio;
    - (B) a profit margin;
    - (C) the premiums to be charged; and
    - (D) such other terms and conditions of coverage as are in the interests of enrollees in such plans.
  - (5) **Authority to protect consumers—** The [Director](/usc/42/11851.md?p=5) may prohibit the offering of any multi-[State](/usc/42/18024.md?p=d) [health plan](/usc/42/18021.md?p=b-1-A) that does not meet the terms and conditions defined by the [Director](/usc/42/11851.md?p=5) with respect to the elements described in subparagraphs [(A)](#a-4-A) through [(D)](#a-4-D) of paragraph (4).
  - (6) **Assured availability of varied coverage—** In entering into contracts under this subsection, the [Director](/usc/42/11851.md?p=5) shall ensure that with respect to multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) offered in an Exchange, there is at least one such plan that does not provide coverage of services described in [section 18023(b)(1)(B)(i) of this title](/usc/42/18023.md?p=b-1-B-i).
  - (7) **Withdrawal—** Approval of a contract under this subsection may be withdrawn by the [Director](/usc/42/11851.md?p=5) only after notice and opportunity for hearing to the issuer concerned without regard to subchapter II of [chapter 5](/usc/42/chch5.md) and chapter 7 of title 5.
- (b) **Eligibility—** A [health insurance issuer](/usc/42/18021.md?p=b-2) shall be eligible to enter into a contract under [subsection (a)(1)](#a-1) if such issuer—
  - (1) agrees to offer a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) that meets the requirements of [subsection (c)](#c) in each Exchange in each [State](/usc/42/18024.md?p=d);
  - (2) is licensed in each [State](/usc/42/18024.md?p=d) and is subject to all requirements of [State](/usc/42/18024.md?p=d) law not inconsistent with this section, including the standards and requirements that a [State](/usc/42/18024.md?p=d) imposes that do not prevent the application of a requirement of part A of title XXVII of the Public Health Service Act [[42 U.S.C. 300gg](/usc/42/300gg.md) et seq.] or a requirement of this title;[^3]
  - (3) otherwise complies with the minimum standards prescribed for carriers offering health benefits plans under [section 8902(e) of title 5](/usc/5/8902.md?p=e) to the extent that such standards do not conflict with a provision of this title;[^3] and
  - (4) meets such other requirements as determined appropriate by the [Director](/usc/42/11851.md?p=5), in consultation with the [Secretary](/usc/42/18024.md?p=c).
- (c) **Requirements for multi-State qualified health plan—**
  - (1) **In general—** A multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) meets the requirements of this subsection if, in the determination of the [Director](/usc/42/11851.md?p=5)—
    - (A) the plan offers a benefits package that is uniform in each [State](/usc/42/18024.md?p=d) and consists of the essential benefits described in [section 18022 of this title](/usc/42/18022.md);
    - (B) the plan meets all requirements of this title[^3] with respect to a [qualified health plan](/usc/42/18021.md?p=a-1), including requirements relating to the offering of the bronze, silver, and gold levels of coverage and catastrophic coverage in each [State](/usc/42/18024.md?p=d) Exchange;
    - (C) except as provided in [paragraph (5)](#c-5), the issuer provides for determinations of premiums for coverage under the plan on the basis of the rating requirements of part A of title XXVII of the Public Health Service Act; and
    - (D) the issuer offers the plan in all geographic regions, and in all [States](/usc/42/18024.md?p=d) that have adopted adjusted community rating before March 23, 2010.
  - (2) **States may offer additional benefits—** Nothing in [paragraph (1)(A)](#c-1-A) shall preclude a [State](/usc/42/18024.md?p=d) from requiring that benefits in addition to the essential health benefits required under such paragraph be provided to enrollees of a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) offered in such [State](/usc/42/18024.md?p=d).
  - (3) **Credits—**
    - (A) **In general—** An individual enrolled in a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) under this section shall be eligible for credits under [section 36B of title 26](/usc/26/36B.md) and cost sharing assistance under [section 18071 of this title](/usc/42/18071.md) in the same manner as an individual who is enrolled in a [qualified health plan](/usc/42/18021.md?p=a-1).
    - (B) **No additional Federal cost—** A requirement by a [State](/usc/42/18024.md?p=d) under [paragraph (2)](#c-2) that benefits in addition to the essential health benefits required under [paragraph (1)(A)](#c-1-A) be provided to enrollees of a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) shall not affect the amount of a premium tax credit provided under [section 36B of title 26](/usc/26/36B.md) with respect to such plan.
  - (4) **State must assume cost—** A [State](/usc/42/18024.md?p=d) shall make payments—
    - (A) to an individual enrolled in a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) offered in such [State](/usc/42/18024.md?p=d); or
    - (B) on behalf of an individual described in [subparagraph (A)](#c-4-A) directly to the multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) in which such individual is enrolled;

    to defray the cost of any additional benefits described in [paragraph (2)](#c-2).

  - (5) **Application of certain State rating requirements—** With respect to a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) that is offered in a [State](/usc/42/18024.md?p=d) with age rating requirements that are lower than 3:1, the [State](/usc/42/18024.md?p=d) may require that Exchanges operating in such [State](/usc/42/18024.md?p=d) only permit the offering of such multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) if such plans comply with the [State](/usc/42/18024.md?p=d)’s more protective age rating requirements.
- (d) **Plans deemed to be certified—** A multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) that is offered under a contract under [subsection (a)](#a) shall be deemed to be certified by an Exchange for purposes of [section 18031(d)(4)(A) of this title](/usc/42/18031.md?p=d-4-A).
- (e) **Phase-in—** Notwithstanding paragraphs [(1)](#b-1) and [(2)](#b-2) of subsection (b), the [Director](/usc/42/11851.md?p=5) shall enter into a contract with a [health insurance issuer](/usc/42/18021.md?p=b-2) for the offering of a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) under [subsection (a)](#a) if—
  - (1) with respect to the first year for which the issuer offers such plan, such issuer offers the plan in at least 60 percent of the [States](/usc/42/18024.md?p=d);
  - (2) with respect to the second such year, such issuer offers the plan in at least 70 percent of the [States](/usc/42/18024.md?p=d);
  - (3) with respect to the third such year, such issuer offers the plan in at least 85 percent of the [States](/usc/42/18024.md?p=d); and
  - (4) with respect to each subsequent year, such issuer offers the plan in all [States](/usc/42/18024.md?p=d).
- (f) **Applicability—** The requirements under [chapter 89](/usc/5/chptIII/sptG/ch89.md) of title 5 applicable to health benefits plans under such chapter shall apply to multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) provided for under this section to the extent that such requirements do not conflict with a provision of this title.[^3]
- (g) **Continued support for FEHBP—**
  - (1) **Maintenance of effort—** Nothing in this section shall be construed to permit the [Director](/usc/42/11851.md?p=5) to allocate fewer financial or personnel resources to the functions of the Office of Personnel Management related to the administration of the Federal Employees Health Benefit Program under chapter 89 of title 5.
  - (2) **Separate risk pool—** Enrollees in multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) under this section shall be treated as a separate risk pool apart from enrollees in the Federal Employees Health Benefit Program under chapter 89 of title 5.
  - (3) **Authority to establish separate entities—** The [Director](/usc/42/11851.md?p=5) may establish such separate units or offices within the Office of Personnel Management as the [Director](/usc/42/11851.md?p=5) determines to be appropriate to ensure that the administration of multi-[State](/usc/42/18024.md?p=d) [qualified health plans](/usc/42/18021.md?p=a-1) under this section does not interfere with the effective administration of the Federal Employees Health Benefit Program under chapter 89 of title 5.
  - (4) **Effective oversight—** The [Director](/usc/42/11851.md?p=5) may appoint such additional personnel as may be necessary to enable the [Director](/usc/42/11851.md?p=5) to carry out activities under this section.
  - (5) **Assurance of separate program—** In carrying out this section, the [Director](/usc/42/11851.md?p=5) shall ensure that the program under this section is separate from the Federal Employees Health Benefit Program under chapter 89 of title 5. Premiums paid for coverage under a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) under this section shall not be considered to be Federal funds for any purposes.
  - (6) **FEHBP plans not required to participate—** Nothing in this section shall require that a carrier offering coverage under the Federal Employees Health Benefit Program under [chapter 89](/usc/5/chptIII/sptG/ch89.md) of title 5 also offer a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1) under this section.
- (h) **Advisory board—** The [Director](/usc/42/11851.md?p=5) shall establish an advisory board to provide recommendations on the activities described in this section. A significant percentage of the members of such board shall be comprised of enrollees in a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](/usc/42/18021.md?p=a-1), or representatives of such enrollees.
- (i) **Authorization of appropriations—** There is authorized to be appropriated, such sums as may be necessary to carry out this section.

## Footnotes

[^1]: So in original. The words “employees health benefit program” probably should be capitalized.
[^2]: So in original. Probably should be “multi-State”.
[^3]: See References in Text note below.

## Source credit

(Pub. L. 111–148, title I, § 1334, as added Pub. L. 111–148, title X, § 10104(q), Mar. 23, 2010, 124 Stat. 902.)

## Notes

### Editorial Notes

### References in Text

The Public Health Service Act, referred to in subsecs. (b)(2) and (c)(1)(C), is act July 1, 1944, ch. 373, 58 Stat. 682. Part A of title XXVII of the Act is classified generally to part A (§ 300gg et seq.) of subchapter XXV of chapter 6A of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables.

This title, referred to in subsecs. (b)(2), (3), (c)(1)(B), and (f), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

### Codification

In subsec. (a)(1), “section 6101 of title 41” substituted for “section 5 of title 41, United States Code,” on authority of Pub. L. 111–350, § 6(c), Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Contracts.