Table of contents
  1. Story
  2. Slides
    1. Slide 1 Data Science for Affordable Care Act Data
    2. Slide 2 Overview
    3. Slide 3  Previous Data Science for HHS
    4. Slide 4 MarkLogic Work for CMS HealthCare.gov: Background
    5. Slide 5 MarkLogic Work for CMS HealthCare.gov: Complexity
    6. Slide 6 MarkLogic Work for CMS HealthCare.gov: Before and After
    7. Slide 7 MarkLogic Work for CMS HealthCare.gov: Architecture
    8. Slide 8 MarkLogic Work for CMS HealthCare.gov: Build Out
    9. Slide 9 MarkLogic Work for CMS HealthCare.gov: Numbers Verified
    10. Slide 10 HealthCare.gov: Health and dental datasets for researchers and issuers
    11. Slide 11 Health Insurance Marketplace Public Use Files (Marketplace PUF)
    12. Slide 12 Marketplace PUF Download
    13. Slide 13 Marketplace PUF
    14. Slide 14 Key Data Science Questions
    15. Slide 15 Data.HealthCare.gov: Datasets
    16. Slide 16 Marketplace PUF Information: PDF to MindTouch Knowledge Base
    17. Slide 17 General Information Factsheet: MindTouch Table for Spreadsheet
    18. Slide 18 ACA Data Spreadsheet Knowledge Base
    19. Slide 19 ACA Data Spotfire Knowledge Base: 1
    20. Slide 20 ACA Data Spotfire Knowledge Base: 2
    21. Slide 21 ACA Data Spotfire Knowledge Base: 3
    22. Slide 22 ACA Data Spotfire Knowledge Base: 4
    23. Slide 23 ACA Data Spotfire Knowledge Base: 5
    24. Slide 24 Conclusions and Recommendations
  3. Spotfire Dashboard
  4. Research Notes
  5. Health and dental plan datasets for researchers and issuers
    1. 2015 plan data
      1. For individuals & families
      2. For small businesses
    2. 2014 plan data
      1. For individuals & families
      2. For small businesses
    3. Health Insurance Marketplace Public Use Files
  6. Health Insurance Marketplace Public Use Files (Marketplace PUF)
    1. Downloads
    2. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
      6. Plan ID Crosswalk PUF
    3. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
  7. Data Resources
    1. Resources Outside of CCIIO
  8. General Information Factsheet
    1. 1. Overview of the PUF
    2. 2. Source Data for the PUF
    3. 3. Description of the PUF
      1. Table 3.1 File Format Descriptions for 2015 Marketplace PUF
      2. Table 3.2 File Format Descriptions for 2014 Marketplace PUF
    4. 4. Variables in the PUF
    5. 5. Methodology and Key Assumptions
    6. 6. Analytic Utility of the PUF
      1. Table 6.1 2015 Marketplace PUF Summary Statistics
      2. Table 6.2 2014 Marketplace PUF Summary Statistics
    7. 7. Support and Further Information
    8. Footnotes
      1. 1
      2. 2
      3. 3
      4. 4
  9. Frequently Asked Questions
    1. Q1. Can you provide us with information that we can use to calculate rates?
    2. Q2. Given that some files in the Health Insurance Marketplace PUF exceed the size limits for Microsoft Excel, how can I view their entire contents?
    3. Q3. Does CMS provide summary data related to health plans and consumer enrollment?
    4. Q4. Where can I find a list of plans that shows service area coverage for each plan?
    5. Q5. Where can I go to get information on the Unified Rate Review public use file?
    6. Q6. How can I learn more about using the HealthCare Finder API?
  10. Data Disclaimer - User Agreement
    1. Data accuracy
    2. Data integrity
    3. Privacy protection
    4. Citation
    5. Additional terms and conditions
  11. Benefits and Cost Sharing Data Dictionary
    1. 1. Overview of the Benefits and Cost Sharing PUF
    2. 2. Variable Attributes
  12. Rate Data Dictionary
    1. 1. Overview of the Rate PUF
    2. 2. Variable Attributes
  13. Plan Attributes Data Dictionary
    1. 1. Overview of the Plans Attributes PUF
    2. 2. Variable Attributes
  14. Business Rules Data Dictionary
    1. 1. Overview of the Business Rules PUF
    2. 2. Variable Attributes
  15. Service Area Data Dictionary
    1. 1. Overview of the Service Area PUF
    2. 2. Variable Attributes
  16. Network Data Dictionary
    1. 1. Overview of the Network PUF
    2. 2. Variable Attributes
  17. Plan ID Crosswalk Data Dictionary
    1. 1. Overview of the Plan ID Crosswalk PUF
      1. Background on the Plan ID Crosswalk Template
    2. 2. Variable Attributes
  18. NEXT

Data Science for ACA

Last modified
Table of contents
  1. Story
  2. Slides
    1. Slide 1 Data Science for Affordable Care Act Data
    2. Slide 2 Overview
    3. Slide 3  Previous Data Science for HHS
    4. Slide 4 MarkLogic Work for CMS HealthCare.gov: Background
    5. Slide 5 MarkLogic Work for CMS HealthCare.gov: Complexity
    6. Slide 6 MarkLogic Work for CMS HealthCare.gov: Before and After
    7. Slide 7 MarkLogic Work for CMS HealthCare.gov: Architecture
    8. Slide 8 MarkLogic Work for CMS HealthCare.gov: Build Out
    9. Slide 9 MarkLogic Work for CMS HealthCare.gov: Numbers Verified
    10. Slide 10 HealthCare.gov: Health and dental datasets for researchers and issuers
    11. Slide 11 Health Insurance Marketplace Public Use Files (Marketplace PUF)
    12. Slide 12 Marketplace PUF Download
    13. Slide 13 Marketplace PUF
    14. Slide 14 Key Data Science Questions
    15. Slide 15 Data.HealthCare.gov: Datasets
    16. Slide 16 Marketplace PUF Information: PDF to MindTouch Knowledge Base
    17. Slide 17 General Information Factsheet: MindTouch Table for Spreadsheet
    18. Slide 18 ACA Data Spreadsheet Knowledge Base
    19. Slide 19 ACA Data Spotfire Knowledge Base: 1
    20. Slide 20 ACA Data Spotfire Knowledge Base: 2
    21. Slide 21 ACA Data Spotfire Knowledge Base: 3
    22. Slide 22 ACA Data Spotfire Knowledge Base: 4
    23. Slide 23 ACA Data Spotfire Knowledge Base: 5
    24. Slide 24 Conclusions and Recommendations
  3. Spotfire Dashboard
  4. Research Notes
  5. Health and dental plan datasets for researchers and issuers
    1. 2015 plan data
      1. For individuals & families
      2. For small businesses
    2. 2014 plan data
      1. For individuals & families
      2. For small businesses
    3. Health Insurance Marketplace Public Use Files
  6. Health Insurance Marketplace Public Use Files (Marketplace PUF)
    1. Downloads
    2. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
      6. Plan ID Crosswalk PUF
    3. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
  7. Data Resources
    1. Resources Outside of CCIIO
  8. General Information Factsheet
    1. 1. Overview of the PUF
    2. 2. Source Data for the PUF
    3. 3. Description of the PUF
      1. Table 3.1 File Format Descriptions for 2015 Marketplace PUF
      2. Table 3.2 File Format Descriptions for 2014 Marketplace PUF
    4. 4. Variables in the PUF
    5. 5. Methodology and Key Assumptions
    6. 6. Analytic Utility of the PUF
      1. Table 6.1 2015 Marketplace PUF Summary Statistics
      2. Table 6.2 2014 Marketplace PUF Summary Statistics
    7. 7. Support and Further Information
    8. Footnotes
      1. 1
      2. 2
      3. 3
      4. 4
  9. Frequently Asked Questions
    1. Q1. Can you provide us with information that we can use to calculate rates?
    2. Q2. Given that some files in the Health Insurance Marketplace PUF exceed the size limits for Microsoft Excel, how can I view their entire contents?
    3. Q3. Does CMS provide summary data related to health plans and consumer enrollment?
    4. Q4. Where can I find a list of plans that shows service area coverage for each plan?
    5. Q5. Where can I go to get information on the Unified Rate Review public use file?
    6. Q6. How can I learn more about using the HealthCare Finder API?
  10. Data Disclaimer - User Agreement
    1. Data accuracy
    2. Data integrity
    3. Privacy protection
    4. Citation
    5. Additional terms and conditions
  11. Benefits and Cost Sharing Data Dictionary
    1. 1. Overview of the Benefits and Cost Sharing PUF
    2. 2. Variable Attributes
  12. Rate Data Dictionary
    1. 1. Overview of the Rate PUF
    2. 2. Variable Attributes
  13. Plan Attributes Data Dictionary
    1. 1. Overview of the Plans Attributes PUF
    2. 2. Variable Attributes
  14. Business Rules Data Dictionary
    1. 1. Overview of the Business Rules PUF
    2. 2. Variable Attributes
  15. Service Area Data Dictionary
    1. 1. Overview of the Service Area PUF
    2. 2. Variable Attributes
  16. Network Data Dictionary
    1. 1. Overview of the Network PUF
    2. 2. Variable Attributes
  17. Plan ID Crosswalk Data Dictionary
    1. 1. Overview of the Plan ID Crosswalk PUF
      1. Background on the Plan ID Crosswalk Template
    2. 2. Variable Attributes
  18. NEXT

  1. Story
  2. Slides
    1. Slide 1 Data Science for Affordable Care Act Data
    2. Slide 2 Overview
    3. Slide 3  Previous Data Science for HHS
    4. Slide 4 MarkLogic Work for CMS HealthCare.gov: Background
    5. Slide 5 MarkLogic Work for CMS HealthCare.gov: Complexity
    6. Slide 6 MarkLogic Work for CMS HealthCare.gov: Before and After
    7. Slide 7 MarkLogic Work for CMS HealthCare.gov: Architecture
    8. Slide 8 MarkLogic Work for CMS HealthCare.gov: Build Out
    9. Slide 9 MarkLogic Work for CMS HealthCare.gov: Numbers Verified
    10. Slide 10 HealthCare.gov: Health and dental datasets for researchers and issuers
    11. Slide 11 Health Insurance Marketplace Public Use Files (Marketplace PUF)
    12. Slide 12 Marketplace PUF Download
    13. Slide 13 Marketplace PUF
    14. Slide 14 Key Data Science Questions
    15. Slide 15 Data.HealthCare.gov: Datasets
    16. Slide 16 Marketplace PUF Information: PDF to MindTouch Knowledge Base
    17. Slide 17 General Information Factsheet: MindTouch Table for Spreadsheet
    18. Slide 18 ACA Data Spreadsheet Knowledge Base
    19. Slide 19 ACA Data Spotfire Knowledge Base: 1
    20. Slide 20 ACA Data Spotfire Knowledge Base: 2
    21. Slide 21 ACA Data Spotfire Knowledge Base: 3
    22. Slide 22 ACA Data Spotfire Knowledge Base: 4
    23. Slide 23 ACA Data Spotfire Knowledge Base: 5
    24. Slide 24 Conclusions and Recommendations
  3. Spotfire Dashboard
  4. Research Notes
  5. Health and dental plan datasets for researchers and issuers
    1. 2015 plan data
      1. For individuals & families
      2. For small businesses
    2. 2014 plan data
      1. For individuals & families
      2. For small businesses
    3. Health Insurance Marketplace Public Use Files
  6. Health Insurance Marketplace Public Use Files (Marketplace PUF)
    1. Downloads
    2. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
      6. Plan ID Crosswalk PUF
    3. Benefits and Cost Sharing PUF
      1. Rate PUF
      2. Plan Attributes PUF
      3. Business Rules PUF
      4. Service Area PUF
      5. Network PUF
  7. Data Resources
    1. Resources Outside of CCIIO
  8. General Information Factsheet
    1. 1. Overview of the PUF
    2. 2. Source Data for the PUF
    3. 3. Description of the PUF
      1. Table 3.1 File Format Descriptions for 2015 Marketplace PUF
      2. Table 3.2 File Format Descriptions for 2014 Marketplace PUF
    4. 4. Variables in the PUF
    5. 5. Methodology and Key Assumptions
    6. 6. Analytic Utility of the PUF
      1. Table 6.1 2015 Marketplace PUF Summary Statistics
      2. Table 6.2 2014 Marketplace PUF Summary Statistics
    7. 7. Support and Further Information
    8. Footnotes
      1. 1
      2. 2
      3. 3
      4. 4
  9. Frequently Asked Questions
    1. Q1. Can you provide us with information that we can use to calculate rates?
    2. Q2. Given that some files in the Health Insurance Marketplace PUF exceed the size limits for Microsoft Excel, how can I view their entire contents?
    3. Q3. Does CMS provide summary data related to health plans and consumer enrollment?
    4. Q4. Where can I find a list of plans that shows service area coverage for each plan?
    5. Q5. Where can I go to get information on the Unified Rate Review public use file?
    6. Q6. How can I learn more about using the HealthCare Finder API?
  10. Data Disclaimer - User Agreement
    1. Data accuracy
    2. Data integrity
    3. Privacy protection
    4. Citation
    5. Additional terms and conditions
  11. Benefits and Cost Sharing Data Dictionary
    1. 1. Overview of the Benefits and Cost Sharing PUF
    2. 2. Variable Attributes
  12. Rate Data Dictionary
    1. 1. Overview of the Rate PUF
    2. 2. Variable Attributes
  13. Plan Attributes Data Dictionary
    1. 1. Overview of the Plans Attributes PUF
    2. 2. Variable Attributes
  14. Business Rules Data Dictionary
    1. 1. Overview of the Business Rules PUF
    2. 2. Variable Attributes
  15. Service Area Data Dictionary
    1. 1. Overview of the Service Area PUF
    2. 2. Variable Attributes
  16. Network Data Dictionary
    1. 1. Overview of the Network PUF
    2. 2. Variable Attributes
  17. Plan ID Crosswalk Data Dictionary
    1. 1. Overview of the Plan ID Crosswalk PUF
      1. Background on the Plan ID Crosswalk Template
    2. 2. Variable Attributes
  18. NEXT

Story

Data Science for the Affordable Care Act

At the last Federal Big Data Working Group Meetup, I was asked to explain how I do data mining and a data science data publication.

I decided to use some recent ACA data sets that I was sent by one of our members. See: Health Insurance Marketplace Public Use Files (Marketplace PUF).

The Marketplace PUF consists of seven separate PDF files, consisting mostly of the data dictionaries that need to be converted to MindTouch and Excel for reuse in analytics and visualizations.

The Marketplace PUF also offered the following caution before you download: The Benefits and Cost Sharing PUF and the Rate PUF datasets included in the zip files are extremely large and may be burdensome to download and/or cause computer performance issues. Downloading the files with the assistance of the Akamai Download Manager application should make downloading the data easier by offering the option to pause and restart downloading to minimize resource allocation impact. Be advised that the file size, once downloaded, may still be prohibitive if you are not using a robust data viewing application. Microsoft Excel has limitations on the number of records it can display, which these two files exceed.

I decided to download these files directly without the Akamai Download Manager application because I have broadband Internet connection and a newer 64 bit PC. I thought: What if I could download and use all of these in Spotfire as Big Data, because it was only 7 ZIP files of 72 MB total, that in turn totaled 1.5 GB of CSV, that became only a 35 MB Spotfire File!

So the answers to the four key data science questions are:

  • How was the data collected?
    • By the CMS ACA program with documentation in PDF files
  • How was the data stored?
    • In two very large Zipped files and 5 smaller Zipped files of CSV that were easily imported into Spotfire were they are now stored in a much more compressed and reusable form for analytics and visualizations.
  • What are the data results?
    • The initial analytics and visualizations are show in the Spotfire Dashboard with one Tab for each of the seven data sets.
  • Why should we believe the data results?
    • Because the data are produced by CMS with documentation and made publicly available for scrutiny.

A recent Data Mining-to-Data Science Data Publication-to-MOOC (Massive Open Online Course) was created for George Mason University entitled Data Science for Data Mining provides an example of the use of the 6 steps in CRISP (Data Mining) Standard being used here.

The following steps were completed:

  • Explore 4 2015 Plan ZIP files
  • Convert 7 PDF to MindTouch
  • Build Spreadsheet Knowledge Base
  • Add Spreadsheet Knowledge Base to Spotfire
  • Add Meetup Content from MarkLogic, etc.
  • Organize Meetup (early July 20)

The background, process, and results are summarized in the Slides.

The conclusions and recommendations are:

  • We Have Done 5 Previous Data Science for HHS Products and Meetups.
  • The MarkLogic Work for CMS HealthCare.gov Has Been Summarized Here Using Their Own Words and Results.
  • Freely Available ACA Data Sets Have Been Downloaded and Used in MindTouch, Excel, and Spotfire Data Science Knowledge Bases.
  • These Data Science Knowledge Bases Are Fully Searchable and Interactive to Discover Interesting and Important Answers to Policy-Relevant Questions.

The PowerPoint Export from Spotfire is provided for use in briefings.

Slides

Slides

Slide 2 Overview

BrandNiemann05052015Slide2.PNG

Slide 3  Previous Data Science for HHS

BrandNiemann05052015Slide3.PNG

Slide 4 MarkLogic Work for CMS HealthCare.gov: Background

BrandNiemann05052015Slide4.PNG

Slide 6 MarkLogic Work for CMS HealthCare.gov: Before and After

BrandNiemann05052015Slide6.PNG

Slide 7 MarkLogic Work for CMS HealthCare.gov: Architecture

http://www.ibm.com/developerworks/da...ex.html?ca=dat

BrandNiemann05052015Slide7.PNG

Slide 8 MarkLogic Work for CMS HealthCare.gov: Build Out

BrandNiemann05052015Slide8.PNG

Slide 9 MarkLogic Work for CMS HealthCare.gov: Numbers Verified

http://www.hhs.gov/news/press/2014pr...20140501a.html

BrandNiemann05052015Slide9.PNG

Slide 10 HealthCare.gov: Health and dental datasets for researchers and issuers

https://www.healthcare.gov/health-an...s-and-issuers/

BrandNiemann05052015Slide10.PNG

Slide 11 Health Insurance Marketplace Public Use Files (Marketplace PUF)

http://www.cms.gov/CCIIO/Resources/D...place-puf.html

BrandNiemann05052015Slide11.PNG

Slide 12 Marketplace PUF Download

BrandNiemann05052015Slide12.PNG

Slide 13 Marketplace PUF

BrandNiemann05052015Slide13.PNG

Slide 14 Key Data Science Questions

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Slide 15 Data.HealthCare.gov: Datasets

https://data.healthcare.gov/browse?l...utf8=%E2%9C%93

BrandNiemann05052015Slide15.PNG

Slide 16 Marketplace PUF Information: PDF to MindTouch Knowledge Base

BrandNiemann05052015Slide16.PNG

Slide 17 General Information Factsheet: MindTouch Table for Spreadsheet

Table 3.1 File Format Descriptions for 2015 Marketplace PUF

BrandNiemann05052015Slide17.PNG

Slide 18 ACA Data Spreadsheet Knowledge Base

ACAData.xlsx

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Slide 19 ACA Data Spotfire Knowledge Base: 1

Web Player

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Slide 20 ACA Data Spotfire Knowledge Base: 2

Web Player

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Slide 21 ACA Data Spotfire Knowledge Base: 3

Web Player

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Slide 22 ACA Data Spotfire Knowledge Base: 4

Web Player

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Slide 23 ACA Data Spotfire Knowledge Base: 5

Web Player

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Slide 24 Conclusions and Recommendations

BrandNiemann05052015Slide24.PNG

Spotfire Dashboard

For Internet Explorer Users and Those Wanting Full Screen Display Use: Web Player Get Spotfire for iPad App

Error: Embedded data could not be displayed. Use Google Chrome

Research Notes

The freely-available ACA datasets are:

https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/    --  Has 2014 and 2015 information on health plans and pricing offered in 35 or so states using the Federally-Facilitated Marketplace. It is the foundation for what the customer sees when they walk into a participating state's health page, enter their zipcode and income level, and want to make plan comparisons and select.a plan. It can be downloaded in total in a zipped file, or interrogated on the fly in Socrata on the page.

http://www.cms.gov/CCIIO/Resources/Data-Resources/marketplace-puf.html -  These Healthcare Insurance Marketplace Public Use FIles (HIMPUFs) contain more detailed info on plan attributes, plan benefits, coverage limits, rates and cost-sharing, but they are larger, which I think is a problem for most casual downloaders.

We are always interested in customer feedback, however critical, so feel free to let me know honestly what you think and I  can make sure it goes to the appropriate peron in-house.

Health and dental plan datasets for researchers and issuers

Source: https://www.healthcare.gov/health-an...s-and-issuers/

The downloadable datasets linked to below will be most useful to researchers, issuers, and others who have a need for the raw data about qualified health plans and stand-alone dental plans offered on healthcare.gov.

The 2015 plan data applies to coverage that starts as early as January 1, 2015 and ends December 31, 2015.

The 2014 plan data applies only to plans offered during 2014, including those purchased after March 31, 2014 with a Special Enrollment Period. All 2014 plans end December 31, 2014.

2015 plan data

For individuals & families

Health plan data My Note: Socrata Download and ZIP File Downloaded

Dental plan data My Note: Socrata Download and ZIP File Downloaded

For small businesses

Health plan data (SHOP) My Note: Socrata Download and ZIP File Downloaded

Dental plan data (SHOP) My Note: Socrata Download and ZIP File Downloaded

2014 plan data

For individuals & families

Health plan data

Dental plan data

Health Insurance Marketplace Public Use Files

Source: http://www.cms.gov/CCIIO/Resources/D...place-puf.html

Researchers requiring detailed plan information should access the Health Insurance Marketplace Public Use Files. These files provide extensive data on the plans available to consumers through the Federally-facilitated Marketplaces. My Note: See Below

Health Insurance Marketplace Public Use Files (Marketplace PUF)

Source: http://www.cms.gov/CCIIO/Resources/D...place-puf.html

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is committed to increasing transparency in the Health Insurance Marketplace. While health plan information including benefits, copayments, premiums, and geographic coverage is publically available on Healthcare.gov, CMS has also released downloadable public use files (PUFs) so that researchers and other stakeholders can more easily access Marketplace data.

The Health Insurance Marketplace Public Use Files (Marketplace PUF) are available for plan years 2014 and 2015 to support timely benefit and rate analysis. It is important to note that the 2015 Marketplace PUF will be updated regularly to reflect the plan data that consumers will see when shopping for a Marketplace Qualified Health Plan (QHP).  The 2014 Marketplace PUF data were imported on July 30, 2014, and data for the 2015 Marketplace PUF were imported to CMS systems on March 2, 2015.

The Marketplace PUF includes plan and issuer level information for certified Qualified Health Plans (QHPs) and stand-alone dental plans (SADPs) offered to individuals and small businesses through the Health Insurance Marketplace. The Marketplace PUF includes data from states participating in the Federally Facilitated Marketplaces (FFM), which include State Partnership Marketplaces (SPMs), and states whose State-based Marketplaces rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF does not contain any data on plans offered in states that established and operate their own Marketplace (State-based Marketplace) and do not rely on the federal platform for QHP eligibility and enrollment functionality, nor does it contain enrollment or claims data.

The Marketplace PUF consists of seven separate files as described below:

  • Benefits and Cost Sharing PUF (BenCS-PUF) – Plan-level data on essential health benefits, coverage limits, and cost sharing.
  • Rate PUF (Rate-PUF) – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
  • Plan Attributes PUF (Plan-PUF) – Plan-level data on maximum out of pocket payments, deductibles, cost sharing, HSA eligibility, formulary ID, and other plan attributes.
  • Business Rules PUF (BR-PUF) – Plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents) and tobacco use.
  • Service Area PUF (SA-PUF) – Issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code.
  • Network (Ntwrk-PUF) – Issuer-level data identifying provider network URLs.
  • Plan ID Crosswalk PUF (CW-PUF) – Plan-level data mapping plans offered in 2014 to plans offered in 2015.

For more information about the Marketplace PUF, please review the General Information Factsheet, Frequently Asked Questions, Data Disclaimer-User Agreement and Data Dictionaries.

To access and download each PUF, click on the associated link in the Downloads section below. My Note: I did this so I can attach them below and convert to MindTouch

Downloads

2015 Marketplace PUF Datasets
Data current as of March 2, 2015

Before you download

The Benefits and Cost Sharing PUF and the Rate PUF datasets included in the zip files are extremely large and may be burdensome to download and/or cause computer performance issues. Downloading the files with the assistance of the Akamai Download Manager application should make downloading the data easier by offering the option to pause and restart downloading to minimize resource allocation impact. Be advised that the file size, once downloaded, may still be prohibitive if you are not using a robust data viewing application. Microsoft Excel has limitations on the number of records it can display, which these two files exceed.

My Note: I am going to download these on my newer 64 bit PC. What if I could download and use all of these in Spotfire as Big Data! It was only 7 ZIP files of 72 MB total. 1.5 GB of CSV becomes a 35 MB Spotfire File!

Benefits and Cost Sharing PUF

Download without Akamai Download Manager

Rate PUF

Download the Rate PUF with Akamai Download Manager

Download without Akamai Download Manager

Plan Attributes PUF

Plan Attributes PUF

Business Rules PUF

Business Rules PUF

Service Area PUF

Service Area PUF

Network PUF

Network PUF

Plan ID Crosswalk PUF

Plan ID Crosswalk PUF

2014 Marketplace PUF Datasets
Data current as of July 30, 2014

Before you download
The Benefits and Cost Sharing PUF and the Rate PUF datasets included in the zip files are extremely large and may be burdensome to download and/or cause computer performance issues. Downloading the files with the assistance of the Akamai Download Manager application should make downloading the data easier by offering the option to pause and restart downloading to minimize resource allocation impact. Be advised that the file size, once downloaded, may still be prohibitive if you are not using a robust data viewing application. Microsoft Excel has limitations on the number of records it can display, which these two files exceed.

Benefits and Cost Sharing PUF

Download without Akamai Download Manager

Plan Attributes PUF

Plan Attributes PUF

Business Rules PUF

Business Rules PUF

Service Area PUF

Service Area PUF

Network PUF

Network PUF

Data Resources

Source: http://www.cms.gov/CCIIO/Resources/D...ces/index.html

This portion of the website contains data and supporting documentation related to CCIIO’s programs and links to other data resources maintained by the Federal government.

Resources Outside of CCIIO

General Information Factsheet

1. Overview of the PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand- alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM) 1, which include states with State Partnership Marketplaces (SPM) 2, Federally-facilitated Small Business Health Options Programs (FF-SHOP), and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality.3 The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.4

The Marketplace PUF is available for plan years 2014 and 2015 to support timely benefit and rate analysis. It is important to note that the 2015 Marketplace PUF will be updated regularly to reflect the plan data that consumers will see when shopping for a Marketplace QHP.

Seven separate files make up the Marketplace PUF: (1) Benefits and Cost Sharing PUF (BenCS-PUF), (2) Plan Attributes PUF (Plan-PUF), (3) Rate PUF (Rate-PUF), (4) Business Rules PUF (BR-PUF), (5) Service Area PUF (SA-PUF), (6) Network PUF (Ntwrk-PUF), and (7) Plan ID Crosswalk PUF (CW-PUF).

2. Source Data for the PUF

The Marketplace PUF contains data submitted by health insurance issuers during the QHP/SADP certification process. In accordance with 45 C.F.R. part 155 subpart K, CMS reviews QHP/SADP applications from issuers that are applying to offer plans in states with FFMs and SPMs. The QHP/SADP application collects both issuer-level information and plan-level benefit and rate data, largely through standardized data templates.

Issuers in states with FFMs complete QHP/SADP applications electronically through the Health Insurance Oversight System (HIOS). Issuers in states with SPMs submit standardized data templates through the System for Electronic Rate and Form Filing (SERFF). Issuers participating in the Multi-State Plan (MSP) Program submit templates through the U.S. Office of Personnel Management’s (OPM) online application portal. CMS has aggregated data from the three systems (HIOS, SERFF, and OPM) to create the Marketplace PUF.

3. Description of the PUF

An overview of the content, format, and size of each of the files that make up the Marketplace PUF is outlined in the tables below.

Table 3.1 File Format Descriptions for 2015 Marketplace PUF

File Name Type* File Size** Description
2015 Benefits and Cost Sharing PUF (BenCS-PUF) CSV 0.6 GB Plan-level data on essential health benefits, coverage limits, and cost sharing.
2015 Plan Attributes PUF (Plan-PUF) CSV 37 MB Plan-level data on maximum out of pocket payments, deductibles, cost sharing, health savings account (HSA) eligibility, formulary ID, and other plan attributes.
2015 Rate PUF (Rate-PUF) CSV 1 GB Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
2015 Business Rules PUF (BR-PUF) CSV 0.8 MB Plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents) and tobacco use.
2015 Service Area PUF (SA-PUF) CSV 2 MB Issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code.
2015 Network PUF (Ntwrk-PUF) CSV 0.2 MB Issuer-level data identifying provider network URLs.
2015 Plan ID Crosswalk PUF (CW-PUF) CSV 15 MB Plan-level data that maps plans offered in 2014 to plans offered in 2015.

*Comma separated values (CSV) **Note: Approximate file sizes.

Table 3.2 File Format Descriptions for 2014 Marketplace PUF

File Name Type* File Size** Description
2014 Benefits and Cost Sharing PUF (BenCS-PUF) CSV 0.3 GB Plan-level data on essential health benefits, coverage limits, and cost sharing.
2014 Plan Attributes PUF (Plan-PUF) CSV 20 MB Plan-level data on maximum out of pocket payments, deductibles, cost sharing, health savings account (HSA) eligibility, formulary ID, and other plan attributes.
2014 Rate PUF (Rate-PUF) CSV 0.7 GB Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
2014 Business Rules PUF (BR-PUF) CSV 0.7 MB Plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents) and tobacco use.
2014 Service Area PUF (SA-PUF) CSV 1.2 MB Issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code.
2014 Network PUF (Ntwrk-PUF) CSV 0.2 MB Issuer-level data identifying provider network URLs.

4. Variables in the PUF

Each file has a separate data dictionary that describes the construction, format, and values of each variable. Users are encouraged to review the data dictionary for each file prior to conducting analysis.

5. Methodology and Key Assumptions

The QHP/SADP application process ensures that plans meet specific QHP/SADP certification standards. To create the Marketplace PUF, CMS has extracted and aggregated data from issuers’ QHP/SADP applications including information on plan design, benefits, cost sharing, rates, and geographic coverage, as these areas represent the core elements of the QHP/SADP application. Data from plans that did not complete the certification process for display on HealthCare.gov or were withdrawn from the certification process have been manually removed from the Marketplace PUF. As the Marketplace PUF only includes information from the QHP/SADP application, it does not contain any enrollment or claims data.

Users should also know that CMS certifies SADPs even if the issuer does not intend to offer them through HealthCare.gov; these plans are referred to as off-exchange SADPs and are included in the Marketplace PUF. CMS does not certify medical plans that are only offered outside of HealthCare.gov. Therefore, the Marketplace PUF does not include data from off-exchange plans other than SADPs. For additional information on the QHP/SADP certification application, review, and certification process, please see: 2015 Letter to Issuers in the Federally-facilitated Marketplace and the 2014 Letter to Issuers in the Federally-facilitated Marketplace.

Users should review the Data Disclaimer-User Agreement for additional background on data accuracy, integrity, and privacy protection.

6. Analytic Utility of the PUF

The 2015 Marketplace PUF contains information on 6,789 QHPs and 1,080 SADPs offered on HealthCare.gov. There are 249 issuers offering QHPs in the individual market and 114 issuers offering QHPs for small businesses. Similarly, there are 189 issuers offering SADPs in the individual market and 159 issuers offering SADPs for small businesses.

The Marketplace PUF also has data on 2,173 off-exchange SADPs. There are 107 issuers offering off- exchange SADPs in the individual market and 427 issuers offering SADPs for small businesses.

Table 6.1 2015 Marketplace PUF Summary Statistics

Total Number/Category QHPs Individual QHPs SHOP SADPs On-Exchange Individual SADPs On-Exchange SHOP SADPs Off-Exchange Individual SADPs Off-Exchange SHOP
Total Number of Issuers 249 114 189 159 107 427
Total Number of Plans 4,580 2,209 646 434 376 1,797

The 2014 Marketplace PUF contains information on 4,402 QHPs and 1,439 SADPs offered on HealthCare.gov. There are 191 issuers offering QHPs in the individual market and 117 issuers offering QHPs for small businesses. Similarly, there are 143 issuers offering SADPs in the individual market and 164 issuers offering SADPs for small businesses.

The Marketplace PUF also has data on 1,162 off-exchange SADPs. There are 64 issuers offering off- exchange SADPs in the individual market and 179 issuers offering SADPs for small businesses.

Table 6.2 2014 Marketplace PUF Summary Statistics

Total Number/Category QHPs Individual QHPs SHOP SADPs On-Exchange Individual SADPs On-Exchange SHOP SADPs Off-Exchange Individual SADPs Off-Exchange SHOP
Total Number of Issuers 191 117 143 164 64 179
Total Number of Plans 2,890 1,512 622 817 305 857

7. Support and Further Information

Users with questions about the Marketplace PUF, the Marketplace data validation process, or QHP/SADP certification, should contact QHPinfo_data@cms.hhs.gov. Responses to PUF-related questions will be released regularly in a Frequently Asked Questions (FAQ) document posted to http://www.cms.gov/CCIIO/Resources/D...place-puf.html. CMS will only respond to questions related to the Marketplace PUF, and will not respond to questions about developer tools or other public use files. The Marketplace PUF will be updated regularly to incorporate any approved data correction.

Footnotes

1

FFM states include Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Louisiana, Mississippi (individual market), Missouri, New Jersey, North Carolina, North Dakota, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

2

SPM states include Arkansas, Delaware, Iowa, Illinois, Kansas, Maine, Michigan, Montana, Nebraska, New Hampshire, Ohio, South Dakota, Utah (individual market), Virginia, and West Virginia.

3

These states include Nevada, New Mexico (individual market), and Oregon (individual market).

4

SBM states include California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts Minnesota, Mississippi (SHOP), New Mexico (SHOP), New York, Oregon (SHOP), Rhode Island, Utah (SHOP), Vermont, and Washington.

Frequently Asked Questions

Updated: January 15, 2015

Q1. Can you provide us with information that we can use to calculate rates?

A1. Data that can be used to calculate rates is available in the Rates and Business Rules PUF Files on the Health Insurance Marketplace PUF webpage. All Qualified Health Plans (QHPs) are required to comply with federal and applicable state rating curves. For additional information about rating curves and tobacco rating rules please see the Final Rule on Rate Review, associated information on State Specific Rating Variations, and CMS Sub-Regulatory Guidance Regarding Age Curves, Geographical Rating Areas and State Reporting.

Q2. Given that some files in the Health Insurance Marketplace PUF exceed the size limits for Microsoft Excel, how can I view their entire contents?

A2. Microsoft Excel (versions 2007-2013) worksheets cannot exceed 1,048,576 rows (earlier versions cannot exceed 65,636 rows) and the size of the workbook is limited based on available memory of the computer you are using to open the files. The Rate PUF and Benefits and Cost Sharing PUF exceed this limit, therefore when attempting to open either of these files directly in Excel, the user will receive an error indicating that the file has not loaded completely.

To view the entire contents of these files you may open them using a statistical or database program such as SAS, SPSS, or Microsoft Access using the program’s import feature and consulting the program’s user documentation. You may also view the contents of these files by segmenting the file using Notepad or another text editor.

Q3. Does CMS provide summary data related to health plans and consumer enrollment?

A3. For summary data related to health plans and consumer enrollment please visit HHS’s Facts and Figures webpage. In addition, users of the Health Insurance Marketplace PUF data should review the associated Data Dictionary documents at Health Insurance Marketplace PUF to guide their research questions and activities.

Q4. Where can I find a list of plans that shows service area coverage for each plan?

A4. The Service Area PUF contains data about the service area including counties and zip codes covered by each issuer that offers plans on HealthCare.gov. Each issuer is identified by a unique five digit issuer ID. The Plan Attributes PUF shows the service area that each plan covers. You can use the information contained in both of these files to determine which plans are available in a given set of counties. You can also identify county and service area coverage using the QHP Landscape Files available on the HealthCare.gov Researchers and Issuers webpage.

Q5. Where can I go to get information on the Unified Rate Review public use file?

A5. The Unified Rate Review public use file is available at http://www.cms.gov/CCIIO/Resources/D...atereview.html. Questions related to the URR Extracts posted to data.healthcare.gov should be directed to RateReview@hhs.gov.

Q6. How can I learn more about using the HealthCare Finder API?

A6. Please visit the HealthCare Finder API webpage for more information and answers to frequently asked questions.

Data Disclaimer - User Agreement

The Centers for Medicare & Medicaid Services (CMS) is pleased to make available the Health Insurance Marketplace Public Use Files (Marketplace PUFs), containing data related to Qualified Health Plans (QHPs), including Stand-alone Dental Plans (SADPs), to the public as free downloads. The Marketplace PUF is intended to support the use and analysis of this this type of data.

This disclaimer-user agreement details the sources and nature of the data, including potential limitations, and specifies the responsibility of the data user in regard to the processing and understanding of the data files. In addition to this disclaimer-user agreement, users should also read the Marketplace PUF General Information Factsheet and the Data Dictionaries.

Data accuracy

The Marketplace PUF is available for plan year 2014 and plan year 2015 to support timely benefit and rate analysis. It is important to note that the 2015 Marketplace PUF will be updated regularly to reflect the plan data that consumers will see when shopping for a Marketplace QHP. The Marketplace PUF does not include data from State Based Marketplaces (SBMs) that do not rely on the federal platform for QHP eligibility and enrollment functionality. Please read the Marketplace PUF General Information Factsheet, as well as the Data Dictionaries for each of the files that comprise the Marketplace PUF, before conducting any analyses with these data.

Data integrity

It is the responsibility of each user to identify the information needed to satisfy the user’s needs. Any alteration of the original data, including conversion to other media or other data formats, is the responsibility of the user. Data that have been manipulated or reprocessed by the user is the responsibility of the user. The user may not present or otherwise reference data that have been altered in any way as CMS data. CMS has no responsibility for the data after it has been converted, processed, or otherwise altered. CMS has no responsibility for assisting users with converting the data to another format. The Marketplace PUF is made available as downloadable comma-separated values (CSV) files. The Marketplace PUF General Information Factsheet contains specific information concerning file format, size, and contents. The Data Dictionaries for each of the seven files that make up the Marketplace PUF define the construction, format, and allowable values for all variables.

Privacy protection

The Marketplace PUF does not include any enrollment or claims data as these data are not collected as part of the QHP certification process.

Citation

Please reference the Marketplace PUF datasets using the following citation format:

Centers for Medicare & Medicaid Services. (2014). 2015 Health Insurance Marketplace Public Use Files (Specific data file name – e.g., Plan Attributes PUF) [Data file and code book]. Retrieved from http://www.cms.gov/CCIIO/Resources/D...place-puf.html

Centers for Medicare & Medicaid Services. (2014). 2014 Health Insurance Marketplace Public Use Files (Specific data file name – e.g., Plan Attributes PUF) [Data file and code book]. Retrieved from http://www.cms.gov/CCIIO/Resources/D...place-puf.html

Additional terms and conditions

The user acknowledges that CMS reserves the right to amend or modify this disclaimer-user agreement and that future access to, downloading, or use of the Marketplace PUF may be subject to revised or additional terms and conditions.

Benefits and Cost Sharing Data Dictionary

1. Overview of the Benefits and Cost Sharing PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Benefits and Cost Sharing PUF (BenCS-PUF) is one of the seven files that make up the Marketplace PUF. The BenCS-PUF contains plan-level data on essential health benefits, coverage limits, and cost sharing for each QHP and SADP. These data either originate from the Plans & Benefits template (i.e., template field), an Excel-based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).

This data dictionary describes the variables contained in the BenCS-PUF. Each record relates to the coverage of a single benefit by one issuer’s insurance plan. The BenCS-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

BusinessYear

Year for which plan provides coverage to enrollees Text Business Year 2014 and 2015 System-generated field Business Year N/A

StateCode

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A

IssuerId

Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free text System-generated field Issuer ID N/A

SourceName

Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A

VersionNum

Integer value for version of data import Text Version Number Free text System-generated field Version Number N/A

ImportDate

Date of data import Date/Time Import Date Free text System-generated field Import Date N/A

IssuerId2

Five-digit numeric code that identifies the issuer organization in HIOS Text Issuer ID Free text Template field HIOS Issuer ID Equal to IssuerId field

StateCode2

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations Template field Issuer State Equal to StateCode field

StandardComponentId

Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS Text Plan ID Free text Template field HIOS Plan ID (Standard Component) N/A

PlanId

Seventeen-character alpha-numeric code that identifies an insurance plan’s cost sharing reduction variant within HIOS Text Plan ID (Standard Component ID with Variant) Free text Template field HIOS Plan ID (Standard Component + Variant) Character count includes ‘-‘

BenefitName

Name assigned to benefit Text Benefit Name Free text Template field Benefits N/A

CopayInnTier1

Dollar amount for In Network Copay for Tier 1 for a benefit Text Copay In Network (Tier 1) No Charge No Charge after deductible $X Copay $X Copay after deductible $X Copay before deductible $X Copay per Day $X Copay per Stay Template field Copay In Network (Tier 1) This field is only required for covered benefits; field will usually be blank for benefits that are not covered but could contain a value; copay amount applies to each enrollee

CopayInnTier2

Dollar amount for In Network Copay for Tier 2 for a benefit Text Copay In Network (Tier 2) No Charge No Charge after deductible $X Copay $X Copay after deductible $X Copay before deductible $X Copay per Day $X Copay per Stay Template field Copay In Network (Tier 2) This field is only required for covered benefits and plans with multiple in network tiers; field will usually be blank for benefits that are not covered but could contain a value; copay amount applies to each enrollee

CopayOutofNet

Dollar amount for Out of Network Copay for a benefit Text Copay Out of Network No Charge No Charge after deductible $X Copay $X Copay after deductible $X Copay before deductible $X Copay per Day $X Copay per Stay Template field Copay Out of Network This field is only required for covered benefits; field will usually be blank for benefits that are not covered but could contain a value; copay amount applies to each enrollee

CoinsInnTier1

Numeric value for In Network Coinsurance percentage for Tier 1 for a benefit Text Coinsurance In Network (Tier 1) No Charge No Charge after deductible X% X% Coinsurance after deductible Template field Coinsurance In Network (Tier 1) This field is only required for covered benefits; field will usually be blank for benefits that are not covered but could contain a value; coinsurance amount applies to each enrollee

CoinsInnTier2

Numeric value for In Network Coinsurance percentage for Tier 2 for a benefit Text Coinsurance In Network (Tier 2) No Charge No Charge after deductible X% X% Coinsurance after deductible Template field Coinsurance In Network (Tier 2) This field is only required for covered benefits and plans with multiple in network tiers; field will usually be blank for benefits that are not covered but could contain a value; coinsurance amount applies to each enrollee

CoinsOutofNet

Numeric value for Out of Network Coinsurance percentage for a benefit Text Coinsurance Out of Network No Charge No Charge after deductible X% X% Coinsurance after deductible Template field Coinsurance Out of Network This field is only required for covered benefits; field will usually be blank for benefits that are not covered but could contain a value; coinsurance amount applies to each enrollee

IsEHB

Categorical indicator of whether benefit is considered an essential health benefit Text EHB Indicator Yes blank Template field EHB Blank values are equivalent to No

IsStateMandate

Categorical indicator of whether benefit is required by state Text State Required Benefit Indicator Yes blank Template field State-Required Benefit Blank values are equivalent to No

IsCovered

Categorical indicator of whether benefit is covered by the insurance plan Text Is this Benefit Covered? Covered Not Covered (or blank) Template field Is this Benefit Covered? Blank values are equivalent to Not Covered

QuantLimitOnSvc

Categorical indicator of whether benefit has a quantitative limit Text Quantitative Limit on Service Yes No (or blank) Template field Quantitative Limit on Service This field is only required for covered benefits; blank values are equivalent to No

LimitQty

Numeric value for coverage limit on the benefit Text Limit Quantity Free text Template field Limit Quantity This field is required if QuantLimitOnSvc field equals Yes

LimitUnit

The unit of measure for the coverage limit on the benefit Text Limit Unit Hours per week Hours per month Hours per year Days per week Days per month Days per year Months per year Visits per week Visits per month Visits per year Lifetime visits Treatments per week Treatments per month Lifetime treatments Lifetime admissions Procedures per week Procedures per month Procedures per year Lifetime procedures Dollar per year Dollar per visit Days per admission Procedures per episode Template field Limit Unit This field is required if QuantLimitOnSvc field equals Yes

MinimumStay

Numeric value for the minimum number of hours of in-patient care that a patient must be provided for this benefit Text Minimum Stay Free text Template field Minimum Stay This field is optional; blanks indicate a value was not provided

Exclusions

The list of services or diagnoses that are excluded from the benefit Text Exclusions Free text Template field Exclusions This field is optional; blanks indicate a value was not provided; field could be truncated at 256 characters if exported to Excel or Access

Explanation

Notes provided to further clarify benefit coverage limits or exclusions Text Benefit Explanation Free text Template field Benefit Explanation This field is optional; blanks indicate a value was not provided; field could be truncated at 256 characters if exported to Excel or Access

EHBVarReason

The justification for not using the prepopulated EHB benefit information from the template Text EHB Variance Reason Above EHB Substituted Substantially Equal Using Alternate Benchmark Other Law/Regulation Additional EHB Benefit Dental Only Plan Available Template field EHB Variance Reason This field is only required if the issuer made changes to the prepopulated template values

IsSubjToDedTier1

Categorical indicator of whether the enrollee is required to pay a Tier 1 deductible for this benefit Text Is Subject to Deductible Tier 1 Yes No Template field Subject to Deductible (Tier 1) N/A

IsSubjToDedTier2

Categorical indicator of whether the enrollee is required to pay a Tier 2 deductible for this benefit Text Is Subject to Deductible Tier 2 Yes No Template field Subject to Deductible (Tier 2) N/A

IsExclFromInnMOOP

Categorical indicator of whether the cost associated with this benefit is excluded from the in network maximum out-of-pocket payment total Text Is Excluded from In Network MOOP Yes No Template field Excluded from In Network MOOP N/A

IsExclFromOonMOOP

Categorical indicator of whether the cost associated with this benefit is excluded from the out of network maximum out-of-pocket payment total Text Is Excluded from Out of Network MOOP Yes No Template field Excluded from Out of Network MOOP N/A

RowNumber

Integer value for template row number associated with this data record Text Row Number Free text System-generated field RowNumber Unavailable for some templates

Rate Data Dictionary

1. Overview of the Rate PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Rate PUF (Rate-PUF) is one of the seven files that make up the Marketplace PUF. The Rate-PUF contains plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location. These data either originate from the Rate Table template (i.e., template field), an Excel based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).

This data dictionary describes the variables contained in the Rate-PUF. Each record relates to one issuer’s rates based on plan, geographic rating area, and subscriber eligibility requirements. The Rate-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

BusinessYear

Year for which plan provides coverage to enrollees Text Business Year 2014 2015 System-generated field Business Year N/A

StateCode

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A

IssuerId

Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free Text System-generated field Issuer ID N/A

SourceName

Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A

VersionNum

Integer value for version of data import Text Version Number Free Text System-generated field Version Number N/A

ImportDate

Date of data import Date/Time Import Date Free Text System-generated field Import Date N/A

IssuerId2

Five-digit numeric code that identifies the issuer organization in HIOS Text Issuer ID (repeated) Free Text Template field HIOS Issuer ID Issuer ID is repeated because of tool data import requirements

FederalTIN

Tax ID Number of issuer Text Tax Identification Number Free Text Template field Federal TIN N/A

RateEffectiveDate

Date that the foundation insurance plan base rate started being used to determine the federally facilitated exchange rate for a specific insurance plan Date Rate Effective Date Free Text Template field Rate Effective Date N/A

RateExpirationDate

Date that the foundation insurance plan base rate stopped being used to determine the federally facilitated exchange rate for a specific insurance plan Date Rate Expiration Date Free Text Template field Rate Expiration Date N/A

PlanId

Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS Text Plan ID Free Text Template field Plan ID N/A

RatingAreaId

Identifier for the geographic rating area within a state Text Rating Area ID Rating Area n, where n is an integer between 1 and 150 Template field Rating Area ID Each rating area identifier maps to a geographic region within the state (e.g., one or more counties, three-digit zip codes, or metropolitan statistical areas)

Tobacco

Categorical indicator of whether a subscriber's tobacco use is used to determine rate eligibility for the insurance plan Text Tobacco Tobacco User/Non-Tobacco User No Preference Template field Tobacco N/A

Age

Categorical indicator of whether a subscriber's age is used to determine rate eligibility for the insurance plan Text Age Family Option 0-20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and over Template field Age N/A

IndividualRate

Dollar value for the insurance premium cost applicable to a non-tobacco user for the insurance plan in a rating area, or to a general subscriber if there is no tobacco preference Text Individual Rate Free Text Template field Individual Rate N/A

IndividualTobaccoRate

Dollar value for the insurance premium cost applicable to a tobacco user for the insurance plan in a rating area Text Individual Tobacco Rate Free Text Template field Individual Tobacco Rate This field is only applicable if Tobacco field equals Tobacco User/Non-Tobacco User

Couple

Dollar value for the insurance premium cost applicable to the primary enrollee plus a secondary subscriber for the insurance plan in a rating area Text Couple Free Text Template field Couple This field is only applicable if Age field equals Family Option

PrimarySubscriberAndOneDependent

Dollar value for the insurance premium cost applicable to the primary enrollee plus one dependent for the insurance plan in a rating area Text Primary Subscriber and One Dependent Free Text Template field Primary Subscriber and One Dependent This field is only applicable if Age field equals Family Option

PrimarySubscriberAndTwoDependents

Dollar value for the insurance premium cost applicable to the primary enrollee plus two dependents for the insurance plan in a rating area Text Primary Subscriber and Two Dependents Free Text Template field Primary Subscriber and Two Dependents This field is only applicable if Age field equals Family Option

PrimarySubscriberAndThreeOrMoreDependents

Dollar value for the insurance premium cost applicable to the primary enrollee plus three or more dependents for the insurance plan in a rating area Text Primary Subscriber and Three or More Dependents Free Text Template field Primary Subscriber and Three or More Dependents This field is only applicable if Age field equals Family Option

CoupleAndOneDependent

Dollar value for the insurance premium cost applicable to the primary enrollee plus a secondary subscriber and one dependent for the insurance plan in a rating area Text Couple and One Dependent Free Text Template field Couple and One Dependent This field is only applicable if Age field equals Family Option

CoupleAndTwoDependents

Dollar value for the insurance premium cost applicable to the primary enrollee plus a secondary subscriber and two dependents for the insurance plan in a rating area Text Couple and Two Dependents Free Text Template field Couple and Two Dependents Couple and Two Dependents

CoupleAndThreeOrMoreDependents

Dollar value for the insurance premium cost applicable to the primary enrollee plus a secondary subscriber and three or more dependents for the insurance plan in a rating area Text Couple and Three or More Dependents Free Text Template field Couple and Three or More Dependents This field is only applicable if Age field equals Family Option

RowNumber

Integer value for template row number associated with this data record Text Row Number Free Text System-generated field Row Number Unavailable for some templates

Plan Attributes Data Dictionary

1. Overview of the Plans Attributes PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Plan Attributes PUF (Plan-PUF) is one of the seven files that make up the Marketplace PUF. The Plan-PUF contains plan-level data on maximum out of pocket payments, deductibles, cost sharing, health savings account (HSA) eligibility, formulary ID, and other plan attributes. These data either originate from the Plans & Benefits template (i.e., template field), an Excel based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated). The issuer can also import data created in other templates (e.g., Network IDs from the Network ID template, Service Area IDs from the Service Area template, and Formulary IDs from the Prescription Drug template) to use as allowable values for the applicable fields in the Plans & Benefits template, or enter these values manually.

This data dictionary describes the variables contained in the Plan-PUF. Each record relates to one issuer’s insurance plan. The Plan-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments
BusinessYear Year for which plan provides coverage to enrollees Text Business Year 2014 2015 System-generated field Business Year N/A
StateCode Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A
IssuerId Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free text System-generated field Issuer ID N/A
SourceName Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A
VersionNum Integer value for version of data import Text Version Number Free text System-generated field Version Number N/A
ImportDate Date of data import Date/Time Import Date Free text System-generated field Import Date N/A
BenefitPackageId Numeric identifier of benefit package Text   Free text System-generated field Benefit Package ID N/A
IssuerId2 Five-digit numeric code that identifies the issuer organization in HIOS Text Text Free text Template field HIOS Issuer ID Equal to IssuerId field
StateCode2 Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations Template field Issuer State Equal to StateCode field
MarketCoverage Categorical indicator of market coverage of plan Text Market Coverage Individual SHOP (Small Group) Template field Market Coverage N/A
DentalOnlyPlan Categorical indicator of dental-only status of plan Text Dental-Only Plan Indicator Yes No Template field Dental Only Plan N/A
TIN Tax ID Number of issuer Text Tax Identification Number Free text Template field TIN N/A
StandardComponentId Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS Text Plan ID Free text Template field HIOS Plan ID (Standard Component) N/A
PlanMarketingName Marketing name of insurance plan Text Plan Marketing Name Free text Template field Plan Marketing Name N/A
HIOSProductId Seven- character alpha-numeric code that identifies an insurance product within HIOS. Text HIOS Product ID Free text Template field HIOS Product ID N/A
PID Identifies the insurance product using a National Health Plan Identifier Text HPID (National Health Plan Identifier) Free text Template field HPID This field is optional; blanks indicate a value was not provided
NetworkId Identifier for a health care provider network organization Text Network ID List of Network IDs valid for the issuer Template field Network ID Network IDs can be imported from the Network ID template based on the number of networks and the issuer’s state, or entered manually by issuer
ServiceAreaId Identifier for a service area Text Service Area ID List of Service Area IDs valid for the issuer Template field Service Area ID Service Area IDs can be imported from the Service Area template based on the number of service areas and the issuer’s state, or entered manually by issuer
FormularyId Identifier for a drug formulary Text Formulary ID List of Formulary IDs valid for the issuer Template field Formulary ID Formulary IDs can be imported from the Prescription Drug template based on the number of formularies and the issuer’s state, or entered manually by issuer; this field is not applicable for dental plans
IsNewPlan Categorical indicator of whether the insurance plan is new for the current year or existed previously in the marketplace Text New/Existing Plan New Existing Template field New/Existing Plan N/A
PlanType Type of insurance plan Text Plan Type Indemnity PPO HMO POS EPO Template field Plan Type N/A
MetalLevel Metal level, or coverage category, of insurance plan based on its actuarial value Text Metal Level Platinum Gold Silver Bronze Catastrophic High Low Template field Level of Coverage Values of High and Low are only applicable for dental plans; values other than High and Low are only applicable to medical plans
UniquePlanDesign An indication that the health insurance plan has a unique design, for purposes of the actuarial value calculator Text Unique Plan Design Yes No Template field Unique Plan Design This field is not applicable for dental plans
QHPNonQHPTypeId Categorical indicator of a plan’s exchange marketplace (On the Exchange, Off the Exchange) Text QHP/Non QHP On Exchange Off Exchange Both Template field QHP/Non QHP N/A
IsNoticeRequiredForPregnancy An indication of whether notice to the issuer is required before pregnancy-related benefits will be covered Text Notice Required for Pregnancy Yes No Template field Notice Required for Pregnancy This field is not applicable for dental plans
IsReferralRequiredForSpecialist An indication of whether pre-authorization is required before a specialist visit Text Is a Referral Required for Specialist? Yes No Template field Is a Referral Required for Specialist? This field is not applicable for dental plans
SpecialistRequiringReferral The types of specialists that require pre-authorization Text Specialist Requiring a Referral Free text Template field Specialist Requiring a Referral This field is not applicable for dental plans; this field is only required if IsReferralRequiredForSpecialist field equals Yes
PlanLevelExclusions The list of exclusions to the insurance plan that apply to all benefits Text Plan Level Exclusions Free text Template field Plan Level Exclusions This field is optional; blanks indicate a value was not provided
IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee Estimated dollar amount of cost–sharing reductions for eligible enrollees to be provided in the form of an advance payment to the issuer Text Limited Cost Sharing Plan Variation - Estimated Advanced Payment Free text Template field Limited Cost Sharing Plan Variation - This field is not applicable for dental plans; this field should be blank for medical plansEst Advanced Payment  
IsHSAEligible An indication that the insurance plan qualifies for a health savings account (HSA) Text HSA Eligible Yes No Template field HSA Eligible This field is not applicable for dental plans
HSAOrHRAEmployerContribution An indication that the employer makes an HSA or health reimbursement arrangement (HRA) contribution Text HSA/HRA Employer Contribution Yes No Template field HSA/HRA Employer Contribution This field is only applicable for medical plans in the SHOP market
HSAOrHRAEmployerContributionAmount The dollar amount per employee that the employer contributes to the HSA or HRA Text HSA/HRA Employer Contribution Amount Free text Template field HSA/HRA Employer Contribution Amount This field is only applicable for medical plans in the SHOP market and only required if HSAOrHRAEmployerContribution field equals Yes
ChildOnlyOffering The types of child enrollment options (Allows Adult and Child-only, Allows Adult-only, Allows Child-only) of an insurance plan Text Child-Only Offering Allows Adult and Child-Only Allows Adult-Only Allows Child-Only Template field Child-Only Offering This field is not applicable for catastrophic plans
ChildOnlyPlanId The HIOS Plan Identifier for the child-only insurance plan that corresponds to this insurance plan Text Child Only Plan ID Free text Template field Child Only Plan ID This field is only applicable for adult-only plans
WellnessProgramOffered An indication of whether an insurance plan offers wellness programs according to Section 2705 of the Public Health Service Act Text Wellness Program Offered Yes No Template field Tobacco Wellness Program Offered This field is not applicable for dental plans
DiseaseManagementProgramsOffered Categorical indicator of whether the plan offers disease management programs for specific conditions Text Disease Management Programs Offered Asthma Heart disease Depression Diabetes High blood pressure & high cholesterol Low back pain Pain management Pregnancy Template field Disease Management Programs Offered This field is not applicable for dental plans
EHBPediatricDentalApportionmentQuantity The dollar amount of the EHB Apportionment for Pediatric Dental Text EHB Apportionment for Pediatric Dental Free text Template field EHB Apportionment for Pediatric Dental This field is not applicable for medical plans
EHBPercentPremiumS4 The projected percent of the plan’s total premium relative to the EHB benchmark plan for the state Text EHB Percent of Total Premium, Section 4 0 -1, blank Template field EHB Percent of TP, Section IV This field is only valid for medical plans
IsGuaranteedRate An indication of whether the rates for the insurance plan are guaranteed or estimated Text Guaranteed Rate Guaranteed Rate Estimated Rate Template field Guaranteed vs. Estimated Rate This field is not applicable for medical plans
SpecialtyDrugMaximumCoinsurance The maximum dollar value of coinsurance for specialty high-cost drugs Text Specialty Drug Maximum Coinsurance Free text Template field Maximum Coinsurance for Specialty Drugs This field is optional; blanks indicate a value was not provided
InpatientCopaymentMaximumDays The maximum number of days for which a patient can be charged a copayment for an inpatient stay, if the insurance plan design charges inpatient stays by day Text Inpatient Copayment Maximum Days 0 (equivalent to no maximum) 1 2 3 4 5 6 7 8 9 10 Template field Maximum Number of Days for Charging an Inpatient Copay? This field is optional, so blanks or zero values indicate a value was not provided
BeginPrimaryCareCostSharingAfterNumberOfVisits The maximum number of fully covered visits allowed, after which primary care cost sharing will begin Text Begin Primary Care Cost-Sharing After Number Of Visits 0 (equivalent to no maximum) 1 2 3 4 5 6 7 8 9 10 Template field Begin Primary Care Cost-Sharing After a Set Number of Visits? This field is optional, so blanks or zero values indicate a value was not provided
BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays The maximum number of primary care visits with co-payment allowed, after which all primary care visits will be subject to the deductible or maximum out of pocket limits Text Begin Primary Care Deductible Coinsurance After Number Of Copays 0 (equivalent to no maximum) 1 2 3 4 5 6 7 8 9 10 Template field Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays? This field is optional, blanks or zero values indicate a value was not provided
PlanEffictiveDate The activation date of enrollment coverage on an Insurance plan Date Plan Effective Date Free text Template field Plan Effective Date N/A
PlanExpirationDate The end date of plan selection for enrollment on an Insurance plan Date Plan Expiration Date Free text Template field Plan Expiration Date This field is optional, so blanks or zero values indicate a value was not provided
OutOfCountryCoverage Indicates whether out of country coverage is provided for health services Text Out of Country Coverage Yes No Template field Out of Country Coverage N/A
OutOfCountryCoverageDescription The conditions under which out of country health services are covered Text Out of Country Coverage Description Free text Template field Out of Country Coverage Description This field is only applicable for plans that offer out of country coverage
OutOfServiceAreaCoverage Indicates whether out of service area coverage is provided Text Out of Service Area Coverage Yes No Template field Out of Service Area Coverage N/A
OutOfServiceAreaCoverageDescription The conditions under which out of service area health services are covered Text Out of Service Area Coverage Description Free text Template field Template field This field is only applicable for plans that offer out of service area coverage
NationalNetwork Indicates whether the insurance plan is supported by a national network of health service provider companies Text National Network Yes No Template field National Network N/A
URLForSummaryofBenefitsCoverage The URL for the Summary of Benefits & Coverage Text URL for Summary of Benefits & Coverage Free text Template field URL for Summary of Benefits & Coverage This field is optional, so blanks or zero values indicate a value was not provided
URLForEnrollmentPayment The URL for Enrollment Payment Text Text Free text Template field URL for Enrollment Payment This field is optional, so blanks or zero values indicate a value was not provided
PlanBrochure The URL for the Plan Brochure Text Plan Brochure Free text Template field Plan Brochure This field is optional, so blanks or zero values indicate a value was not provided
FormularyUR The URL for the prescription drug formulary associated with this plan Text Formulary URL Free text Template field Formulary URL This field is only valid for medical plans
PlanId Seventeen-character alpha-numeric code that identifies an insurance plan’s cost sharing reduction (CSR) variant within HIOS Text Plan ID (Standard Component ID with Variant) Free text Template field HIOS Plan ID (Standard Component + Variant) Prepopulated in template; character count includes
CSRVariationType Name of the cost sharing reduction options offered for a health insurance plan Text CSR Variation Type Standard Off Exchange Plan Standard On Exchange Plan Zero Cost Sharing Plan Variation Limited Cost Sharing Plan Variation 73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Template field CSR Variation Type Prepopulated in template
IssuerActuarialValue The numeric actuarial value (AV) generated manually for an insurance plan by the issuer Percentage Issuer Actuarial Value Free text Template field Issuer Actuarial Value This field is only applicable for dental plans and plans with a unique plan design
AVCalculatorOutputNumber The numeric AV generated by the template’s AV Calculator for an insurance plan Text AV Calculator Output Number Free text Template field AV Calculator Output Number This field is only applicable for medical plans and plans that do not have a unique plan design
MedicalDrugDeductiblesIntegrated An indication of whether the insurance plan specifies that the medical and drug deductibles are combined into one deductible Text Medical Drug Deductibles Integrated Yes No Template field Medical & Drug Deductibles Integrated? This field is not applicable for dental plans
MedicalDrugMaximumOutofPocketIntegrated An indication of whether the insurance plan specifies that the medical and drug maximum out of pocket (MOOP) limits are combined into one limit Text Medical Drug Maximum Out of Pocket Integrated Yes No Template field Medical & Drug Maximum Out of Pocket Integrated? This field is not applicable for dental plans
MultipleInNetworkTiers An indication of whether there are two in network tiers Text Multiple In Network Tiers Yes No Template field Multiple In Network Tiers? N/A
FirstTierUtilization The expected percentage of utilization for the first in network tier Text First Tier Utilization Free text Template field 1st Tier Utilization N/A
SecondTierUtilization The expected percentage of utilization for the second in network tier, based on the value entered for the first tier Text Second Tier Utilization 100% minus First Tier Utilization Template field 2nd Tier Utilization Calculated by template
MEHBInnTier1IndividualMOOP The dollar amount of the tier 1 in network, individual out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBInnTier2IndividualMOOP The dollar amount of the tier 2 in network, individual out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Individual $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBOutOfNetIndividualMOOP The dollar amount of the out of network, individual out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBOutOfNetFamilyMOOP The dollar amount of the out of network, family out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBCombInnOonIndividualMOOP The dollar amount of the combined in/out of network, individual out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Individual This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
MEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-of-pocket cost limit for medical EHB benefits Text Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family $X Not Applicable Template field Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family This field is only applicable for plans with separate medical and drug MOOP limits; for dental plans, this field contains the MOOP value for dental benefits
DEHBInnTier1IndividualMOOP The dollar amount of the tier 1 in network, individual out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBInnTier2IndividualMOOP The dollar amount of the tier 2 in network, individual out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family out-of-pocket cost limit for drug EHB benefits Text Variable Label: Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBOutOfNetIndividualMOOP The dollar amount of the out of network, individual out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBOutOfNetFamilyMOOP The dollar amount of the out of network, family out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBCombInnOonIndividualMOOP The dollar amount of the combined in/out of network, individual out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
DEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-of-pocket cost limit for drug EHB benefits Text Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family $X Not Applicable Template field Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans
TEHBInnTier1IndividualMOOP The dollar amount of the tier 1 in network, individual out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBInnTier2IndividualMOOP The dollar amount of the tier 2 in network, individual out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBOutOfNetIndividualMOOP The dollar amount of the out of network, individual out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBOutOfNetFamilyMOOP The dollar amount of the out of network, family out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBCombInnOonIndividualMOOP The dollar amount of the combined in/out of network, individual out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
TEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-of-pocket cost limit for medical and drug EHB benefits Text Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family $X Not Applicable Template field Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans
MEHBDedInnTier1Individual The dollar amount of the tier 1 in network, individual deductible for medical EHB benefits Text Medical EHB Deductible, In Network (Tier 1), Individual $X Not Applicable Template field Medical EHB Deductible, In Network (Tier 1), Individual This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedInnTier1Family The dollar amount of the tier 1 in network, family deductible for medical EHB benefits Text Medical EHB Deductible, In Network (Tier 1), Family $X Not Applicable Template field Medical EHB Deductible, In Network (Tier 1), Family This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedInnTier1Coinsurance The percentage used for the tier 1 in network coinsurance for medical EHB benefits, unless a different coinsurance is listed for a specific benefit Text Medical EHB Deductible, In Network (Tier 1), Default Coinsurance Free text Template field Medical EHB Deductible, In Network (Tier 1), Default Coinsurance This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
MEHBDedInnTier2Individual The dollar amount of the tier 2 in network, individual deductible for medical EHB benefits Text Medical EHB Deductible, In Network (Tier 2), Individual $X Not Applicable Template field Medical EHB Deductible, In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedInnTier2Family The dollar amount of the tier 2 in network, family deductible for medical EHB benefits Text Medical EHB Deductible, In Network (Tier 2), Family $X Not Applicable Template field Medical EHB Deductible, In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedInnTier2Coinsurance The percentage used for the tier 2 in network coinsurance for medical EHB benefits, unless a different coinsurance is listed for a specific benefit Text Medical EHB Deductible, In Network (Tier 2), Default Coinsurance Free text Template field Medical EHB Deductible, In Network (Tier 2), Default Coinsurance This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; this field will be blank for dental plans
MEHBDedOutOfNetIndividual The dollar amount of the out of network, individual deductible for medical EHB benefits Text Medical EHB Deductible, Out of Network, Individual $X Not Applicable Template field Medical EHB Deductible, Out of Network, Individual This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedOutOfNetFamily The dollar amount of the out of network, family deductible for medical EHB benefits Text Medical EHB Deductible, Out of Network, Family $X Not Applicable Template field Medical EHB Deductible, Out of Network, Family This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedCombInnOonIndividual The dollar amount of the combined in/out of network, individual deductible for medical EHB benefits Text Medical EHB Deductible, Combined In/Out of Network, Individual $X Not Applicable Template field Medical EHB Deductible, Combined In/Out of Network, Individual This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
MEHBDedCombInnOonFamily The dollar amount of the combined in/out of network, family deductible for medical EHB benefits Text Medical EHB Deductible, Combined In/Out of Network, Family $X Not Applicable Template field Medical EHB Deductible, Combined In/Out of Network, Family This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
DEHBDedInnTier1Individual The dollar amount of the tier 1 in network, individual deductible for drug EHB benefits Text Drug EHB Deductible, In Network (Tier 1), Individual $X Not Applicable Template field Drug EHB Deductible, In Network (Tier 1), Individual This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
DEHBDedInnTier1Family The dollar amount of the tier 1 in network, family deductible for drug EHB benefits Text Drug EHB Deductible, In Network (Tier 1), Family $X Not Applicable Template field Drug EHB Deductible, In Network (Tier 1), Family This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits
DEHBDedInnTier1Coinsurance The percentage used for the tier 1 in network coinsurance for drug EHB benefits, unless a different coinsurance is listed for a specific benefit Text Drug EHB Deductible, In Network (Tier 1), Default Coinsurance Free text Template field Drug EHB Deductible, In Network (Tier 1), Default Coinsurance This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedInnTier2Individual The dollar amount of the tier 2 in network, individual deductible for drug EHB benefits Text Drug EHB Deductible, In Network (Tier 2), Individual $X Not Applicable Template field Drug EHB Deductible, In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedInnTier2Family The dollar amount of the tier 2 in network, family deductible for drug EHB benefits Text Drug EHB Deductible, In Network (Tier 2), Family $X Not Applicable Template field Drug EHB Deductible, In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedInnTier2Coinsurance The percentage used for the tier 2 in network coinsurance for drug EHB benefits, unless a different coinsurance is listed for a specific benefit Text Drug EHB Deductible, In Network (Tier 2), Default Coinsurance Free text Template field Drug EHB Deductible, In Network (Tier 2), Default Coinsurance This field is only applicable for plans with multiple in network tiers and separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedOutOfNetIndividual The dollar amount of the out of network, individual deductible for drug EHB benefits Text Drug EHB Deductible, Out of Network, Individual $X Not Applicable Template field Drug EHB Deductible, Out of Network, Individual This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedOutOfNetFamily The dollar amount of the out of network, family deductible for drug EHB benefits Text Drug EHB Deductible, Out of Network, Family $X Not Applicable Template field Drug EHB Deductible, Out of Network, Family This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedCombInnOonIndividual The dollar amount of the combined in/out of network, individual deductible for drug EHB benefits Text Drug EHB Deductible, Combined In/Out of Network, Individual $X Not Applicable Template field Drug EHB Deductible, Combined In/Out of Network, Individual This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
DEHBDedCombInnOonFamily The dollar amount of the combined in/out of network, family deductible for drug EHB benefits Text Drug EHB Deductible, Combined In/Out of Network, Family $X Not Applicable Template field Drug EHB Deductible, Combined In/Out of Network, Family This field is only applicable for plans with separate medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier1Individual The dollar amount of the tier 1 in network, individual deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $X Not Applicable Template field Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier1Family The dollar amount of the tier 1 in network, family deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $X Not Applicable Template field Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier1Coinsurance The percentage used for the tier 1 in network coinsurance for medical and drug EHB benefits, unless a different coinsurance is listed for a specific benefit Text Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance Free text Template field Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier2Individual The dollar amount of the tier 2 in network, individual deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $X Not Applicable Template field Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual This field is only applicable for plans with multiple in network tiers and combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier2Family The dollar amount of the tier 2 in network, family deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family $X Not Applicable Template field Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family This field is only applicable for plans with multiple in network tiers and combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedInnTier2Coinsurance The percentage used for the tier 2 in network coinsurance for medical and drug EHB benefits, unless a different coinsurance is listed for a specific benefit Text Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance Free text Template field Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance This field is only applicable for plans with multiple in network tiers and combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedOutOfNetIndividual The dollar amount of the out of network, individual deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, Out of Network, Individual $X Not Applicable Template field Combined Medical and Drug EHB Deductible, Out of Network, Individual This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedOutOfNetFamily The dollar amount of the out of network, family deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, Out of Network, Family $X Not Applicable Template field Combined Medical and Drug EHB Deductible, Out of Network, Family This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedCombInnOonIndividual The dollar amount of the combined in/out of network, individual deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $X Not Applicable Template field Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
TEHBDedCombInnOonFamily The dollar amount of the combined in/out of network, family deductible for medical and drug EHB benefits Text Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family $X Not Applicable Template field Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family This field is only applicable for plans with combined medical and drug deductibles; this field will be blank for dental plans
SBCHavingaBabyDeductible The dollar amount of the deductible for the sample Summary of Benefits & Coverage (SBC) scenario of having a baby Text SBC Scenario, Having a Baby, Deductible Free text Template field SBC Scenario, Having a Baby, Deductible This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingaBabyCopayment The dollar amount of the copayment for the sample SBC scenario of having a baby Text SBC Scenario, Having a Baby, Copayment Free text Template field SBC Scenario, Having a Baby, Copayment This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingaBabyCoinsurance The dollar amount of the coinsurance for the sample SBC scenario of having a baby Text SBC Scenario, Having a Baby, Coinsurance Free text Template field SBC Scenario, Having a Baby, Coinsurance This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingaBabyLimit The dollar amount of the benefit limits or exclusions for the sample SBC scenario of having a baby Text SBC Scenario, Having a Baby, Limit Free text Template field SBC Scenario, Having a Baby, Limit This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingDiabetesDeductible The dollar amount of the deductible for the sample SBC scenario of having diabetes Text SBC Scenario, Having Diabetes, Deductible Free text Template field SBC Scenario, Having Diabetes, Deductible This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingDiabetesCopayment The dollar amount of the copayment for the sample SBC scenario of having diabetes Text SBC Scenario, Having Diabetes, Copayment Free text Template field SBC Scenario, Having Diabetes, Copayment This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingDiabetesCoinsurance The dollar amount of the coinsurance for the sample SBC scenario of having diabetes Text SBC Scenario, Having Diabetes, Coinsurance Free text Template field SBC Scenario, Having Diabetes, Coinsurance This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
SBCHavingDiabetesLimit The dollar amount of the benefit limits or exclusions for the sample SBC scenario of having diabetes Text SBC Scenario, Having Diabetes, Limit Free text Template field SBC Scenario, Having Diabetes, Limit This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans
RowNumber Template row number associated with this data record Text Row Number Free text System-generated field RowNumber Unavailable for some templates

Business Rules Data Dictionary

1. Overview of the Business Rules PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Business Rules PUF (BR-PUF) is one of the seven files that make up the Marketplace PUF. The BR-PUF contains plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents) and tobacco use. These data either originate from the Business Rules template (i.e., template field), an Excel-based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).

This data dictionary describes the variables contained in the BR-PUF. Each record relates to a set of rules for the application of rates for one plan. The BR-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

BusinessYear

Year for which plan provides coverage to enrollees Text Business Year 2014 2015 System-generated field Business Year N/A

StateCode

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A

IssuerId

Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free Text System-generated field Issuer ID N/A

SourceName

Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A

VersionNum

Integer value for version of data import Text Version Number Free Text System-generated field Version Number N/A

ImportDate

Date of data import Date/Time Import Date Free Text System-generated field Import Date N/A

IssuerId2

Five-digit numeric code that identifies the issuer organization in HIOS Text Issuer ID Free Text Template field HIOS Issuer ID Equal to IssuerId field

TIN

Tax ID Number of issuer Text Tax Identification Number Free Text Template field TIN N/A

ProductId

Ten-character alpha-numeric code that identifies an insurance product within HIOS Text Product ID Free Text Template field Product ID N/A

StandardComponentId

Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS Text Standard Component ID Free Text Template field Plan ID (Standard Component) N/A

EnrolleeContractRateDeterminationRule

Description of enrollee contract rule for determining rates Text Enrollee Contract Rate Determination Rule “There are rates specifically for couples and for families (not just addition of individual rates)” “A different rate (specifically for parties of two or more) for each enrollee is added together” Template field How are rates for contracts covering two or more enrollees calculated? N/A

TwoParentFamilyMaxDependentsRule

The maximum number of dependents used to rate a policy in a two parent family Text Two Parent Family Max Dependents Rule 12 3 or more Template field What are the maximum number of under age (under 21) dependents used to quote a two parent family? N/A

SingleParentFamilyMaxDependentsRule

The maximum number of dependents used to rate a policy in a single parent family Text Single Parent Family Max Dependents Rule 12 3 or more Template field What are the maximum number of under age (under 21) dependents used to quote a single parent family? N/A

DependentMaximumAgRule

Integer value for the maximum age for which an insurance plan could be issued for a child, if applicable Text Dependent Maximum Age Rule Number representing age Not Applicable Template field Is there a maximum age for a dependent? N/A

ChildrenOnlyContractMaxChildrenRule

The maximum number of children used to rate a child-only policy Text Children Only Contract Max Children Rule 12 3 or more Template field What are the maximum number of children used to quote a children-only contract? N/A

DomesticPartnerAsSpouseIndicator

Categorical indicator for whether a domestic partner is treated the same as secondary subscribers Text Domestic Partner As Spouse Indicator Yes No Template field Are domestic partners treated the same as secondary subscribers? N/A

SameSexPartnerAsSpouseIndicator

Categorical indicator for whether a same sex partner is treated the same as secondary subscribers Text Same Sex Partner As Spouse Indicator Yes No Template field Are same-sex partners treated the same as secondary subscribers? N/A

AgeDeterminationRule

Categorical indicator for the method used to determine the person's age at the time of an application Text Age Determination Rule “Age on effective date” “Age on January 1st of the effective date year” “Age on insurance date (age on birthday nearest the effective date)” “Age on January 1st or July 1st “ Template field How is age determined for rating and eligibility purposes? N/A

MinimumTobaccoFreeMonthsRule

Integer value for the number of tobacco-free months considered when qualifying an enrollee for the non-tobacco insurance rate, if applicable Text Minimum Tobacco Free Months Rule Number representing months of no tobacco use Not Applicable Template field How is tobacco status determined for subscribers and dependents? N/A

CohabitationRule

Categorical indicator that identifies which family relationships are allowed for enrollees and whether cohabitation is required Text Cohabitation Rule Spouse, Yes/No Father or Mother, Yes/No Grandfather or Grandmother, Yes/No Grandson or Granddaughter, Yes/No Uncle or Aunt, Yes/No Nephew or Niece, Yes/No Cousin, Yes/No Adopted Child, Yes/No Foster Child, Yes/No Son-in-law or daughter-in-law, Yes/No Brother-in-law or sister-in-law, Yes/No Mother-in-law or father-in law, Yes/No Brother or sister, Yes/No Ward, Yes/No Stepparent, Yes/No Stepson or stepdaughter, Yes/No Self, Yes/No Child, Yes/No Sponsored dependent, Yes/No Dependent on a Minor Dependent, Yes/No Ex-spouse, Yes/No Guardian, Yes/No Court Appointed Guardian, Yes/No Collateral Dependent, Yes/No Life Partner, Yes/No Annultant, Yes/No Trustee, Yes/No Other Relationship, Yes/No Other Relative, Yes/No Template field What relationships between primary and dependent are allowed, and is the dependent required to live in the same household as the primary subscriber? Only relationships allowed by issuer are listed, followed by Yes or No to indicate cohabitation requirement; field may be truncated at 256 characters if exported to Excel or Access

RowNumber

Integer value for template row number associated with this data record Text Row Number Free Text System-generated field Row Number Unavailable for some templates

MarketCoverage

Categorical indicator of market coverage of plans submitted with this template Text Market Coverage Individual SHOP (Small Group) System-generated field Market Coverage Blank for HIOS data (does not apply)

DentalOnlyPlan

Categorical indicator that plan is a stand-alone dental plan Text Dental-Only Plan Indicator Yes No System-generated field Dental-Only Plan Indicator Comments: Blank for HIOS data (does not apply)

Service Area Data Dictionary

1. Overview of the Service Area PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Service Area PUF (SA-PUF) is one of the seven files that make up the Marketplace PUF. The SA-PUF contains issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code. These data either originate from the Service Area template (i.e., template field), an Excel based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).

This data dictionary describes the variables contained in the SA-PUF. Each record relates to one issuer’s geographic area of coverage. The SA-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

BusinessYear

Year for which plan provides coverage to enrollees Text Business Year 2014 2015 System-generated field Business Year N/A

StateCode

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A

IssuerId

Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free Text System-generated field Issuer ID N/A

SourceName

Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A

VersionNum

Integer value for version of data import Text Version Number Free Text System-generated field Version Number N/A

ImportDate

Date of data import Date/Time Import Date Free Text System-generated field Import Date N/A

IssuerId2

Five-digit numeric code that identifies the issuer organization in HIOS Text Issuer ID Free text Template field HIOS Issuer ID Equal to IssuerId field

StateCode2

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations Template field Issuer State Equal to StateCode field

ServiceAreaId

Identifier for a service area Text Service Area ID Service Area IDs shown are generated based on number of service areas entered and issuer’s state Template field Service Area ID N/A

ServiceAreaName

Name of a service area Text Service Area Name Free Text Template field Service Area Name N/A

CoverEntireState

Categorical indicator of whether entire state is covered by the service area Text Cover Entire State Yes No Template field State N/A

County

Federal Information Processing Standards (FIPS) code assigned to the county within a state that is covered by the service area Text County FIPS codes shown are for counties within state selected in template Template field County Name This field is only applicable if CoverEntireState field equals No

PartialCounty

Categorical indicator of whether entire county is covered by the service area Text Partial County Yes No Template field Partial County This field is only applicable if CoverEntireState field equals No

ZipCodes

Zip codes within the partial-county region covered by the service area Text Zip Codes List of zip codes separated by commas Template field Service Area Zip Code(s) This field is only applicable if PartialCounty field equals Yes; field could be truncated at 256 characters if exported to Excel or Access

PartialCountyJustification

The justification given for creating a partial-county region for inclusion in a Service Area. Text Partial County Justification Free Text Template field Partial County Justification This field is only applicable if PartialCounty field equals Yes; field may be truncated at 256 characters if exported to Excel or Access

RowNumber

Integer value for template row number associated with this data record Text Row Number Free Text System-generated field Row Number Unavailable for some templates

MarketCoverage

Categorical indicator of market coverage of plans submitted with this template Text Market Coverage Individual SHOP (Small Group) System-generated field Market Coverage Blank for HIOS data (does not apply)

DentalOnlyPlan

Categorical indicator of dental-only status of plans submitted with this template Text Dental-Only Plan Indicator Yes No System-generated field Dental-Only Plan Indicator Blank for HIOS data (does not apply)

Network Data Dictionary

1. Overview of the Network PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUF in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Network PUF (Ntwrk-PUF) is one of the seven files that make up the Marketplace PUF. The Ntwrk-PUF contains issuer-level data identifying provider network URLs. These data either originate from the Network ID template (i.e., template field), an Excel based form used by issuers to describe their plans in the QHP/SADP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).

This data dictionary describes the variables contained in the Ntwrk-PUF. Each record relates to one issuer’s provider network. The Ntwrk-PUF is available for plan year 2014 and plan year 2015.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

BusinessYear

Year for which plan provides coverage to enrollees Text Business Year 2014 2015 System-generated field Business Year N/A

StateCode

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations System-generated field State Code N/A

IssuerId

Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Text Issuer ID Free Text System-generated field Issuer ID N/A

SourceName

Categorical identifier of source of data import Text Source Name HIOS SERFF OPM System-generated field Source Name N/A

VersionNum

Integer value for version of data import Text Version Number Free Text System-generated field Version Number N/A

ImportDate

Date of data import Date/Time Import Date Free Text System-generated field Import Date N/A

IssuerId2

Five-digit numeric code that identifies the issuer organization in HIOS Text Issuer ID Free Text Template field HIOS Issuer ID Equal to IssuerId field

StateCode2

Two-character state abbreviation indicating the state where the plan is offered Text State Code All 50 state abbreviations + 9 territory abbreviations Template field Issuer State Equal to StateCode field

NetworkName

Name of a health care provider network Text Network Name Free Text Template field Network Name N/A

NetworkId

Identifier for a health care provider network Text Network ID Network IDs shown are generated based on number of networks entered and issuer’s state Template field Network ID N/A

NetworkURL

The URL of the network's provider directory Text Network URL Free Text Template field Network URL N/A

RowNumber

Integer value for template row number associated with this data record Text Row Number Free Text System-generated field Row Number Unavailable for some templates

MarketCoverage

Categorical indicator of market coverage of plans submitted with this template Text Market Coverage Individual SHOP (Small Group) System-generated field Market Coverage Blank for HIOS data (does not apply)

DentalOnlyPlan

Categorical indicator of dental-only status of plans submitted with this template Text Dental-Only Plan Indicator Yes No System-generated field Dental-Only Plan Indicator Blank for HIOS data (does not apply)

Plan ID Crosswalk Data Dictionary

1. Overview of the Plan ID Crosswalk PUF

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing Health Insurance Marketplace Public Use Files (Marketplace PUF) in order to improve transparency and increase access to the Marketplace data. The Marketplace PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states with Federally-facilitated Marketplaces (FFM), which include states with State Partnership Marketplaces (SPM), Federally-facilitated Small Business Health Options Programs (FF-SHOP) and State-based Marketplaces (SBM) that rely on the federal information technology platform for QHP eligibility and enrollment functionality. The Marketplace PUF also includes data on Multi State Plans (MSPs). The Marketplace PUF does not include data from SBMs that do not rely on the federal platform for QHP eligibility and enrollment functionality.

The Plan ID Crosswalk PUF (CW-PUF) is one of the seven files that make up the Marketplace PUF. The purpose of the CW-PUF is to map QHPs and SADPs offered through the Marketplaces in 2014 to plans that will be offered through the Marketplaces in 2015. These data either originate from the Plan Crosswalk template (i.e., template field), an Excel-based form used by issuers to describe their plans in the QHP application process, or were generated by CCIIO for use in data processing (i.e., system-generated).This data dictionary describes the variables contained in the CW-PUF. Each record relates to a mapping between a plan offered in 2014 and a plan offered in 2015 at the county or county-zip code level.

Background on the Plan ID Crosswalk Template

The FFM Plan ID Crosswalk Template crosswalks 2014 Qualified Health Plan (QHP) plan ID and service area combinations (e.g., Plan ID and County combinations) to a 2015 QHP plan ID. These data will facilitate 834 automatic re-enrollment transactions from CMS to the issuer in December 2014 for those enrollees who have not actively selected a different QHP during open enrollment at that time. The Plan ID Crosswalk template itself and the instructions to issuers can be found here: http://www.serff.com/plan_management...lates_2015.htm. The template instructions in particular will be helpful for those who would like a better understanding of the context and meaning of certain CW-PUF data elements.

2. Variable Attributes

Variable Name Variable Definition Data Type Variable Label Allowable Values Data Source Field Name from Data Source Comments

State

Two-character state abbreviation indicating the state where the plan is offered Text State All 50 state abbreviations + 9 territory abbreviations Template field Issuer State N/A

DentalPlan

Categorical indicator that plan is a stand-alone dental plan (SADP) Text Dental Plan Y N Template field Dental Only Plan N/A

PlanID_2014

Fourteen-character alpha-numeric code that identifies the 2014 insurance plan in the Health Insurance Oversight System (HIOS) Text 2014 Plan ID Free text Template field 2014 HIOS Plan ID (Standard Component) N/A

IssuerID_2014

Five-digit numeric code that identifies the issuer organization in HIOS for the 2014 plan Text 2014 Issuer ID Free text Template field HIOS Issuer ID N/A

MultistatePlan_2014

Categorical indicator of whether the 2014 plan is a multi-state plan Text 2014 Multistate Plan Y N Template field Multi-State Plan N/A

MetalLevel_2014

Metal level, or coverage category, of the 2014 plan based on its actuarial value Text 2014 Metal Level Platinum Gold Silver Bronze Catastrophic High Low System-generated field Metal Level 2014 Values of High and Low are only applicable for dental plans; values other than High and Low are only applicable to medical plans

ChildAdultOnly_2014

The types of child enrollment options for the 2014 plan Text 2014 Child Adult Only 0 1 2 System-generated field Child Adult Only 2014 A value of 0 means the 2014 plan allows adult-only and child-only enrollment; a value of 1 means the 2014 plan allows only child-only enrollment; a value of 2 means the 2014 plan allows only adult-only enrollment

FIPSCode

Federal Information Processing Standards (FIPS) code assigned to the county within a state that is included in the plan’s service area Text FIPS Code FIPS codes for counties within issuer state Template field County Name N/A

ZipCode

Five-digit zip code within the partial-county region included in the plan’s service area Text Zip Codes Zip codes within issuer state Template field Service Area Zip Code(s) A value of “00000” means the issuer did not split the county into zip codes when submitting the Plan Crosswalk Template (i.e., the entire county is covered by the plan)

CrosswalkLevel

Categorical indicator of the crosswalk level Text Crosswalk Level 0 1 2 3 4 5 Template field Crosswalk Level A value of 0 equals Crosswalking to the same Plan ID; a value of 1 equals Crosswalking at the Plan ID level; a value of 2 equals Crosswalking at the Plan ID and county coverage level; a value of 3 equals Crosswalking at the zip-code level for one or more counties; a value of 4 equals Discontinue 2014 plan with no cross walk (no re-enrollment option in 2015); a value of 5 equals 2014 Plan withdrawn prior to certification

ReasonForCrosswalk

Categorical indicator of the reason for the crosswalk Text Reason for Crosswalk 0 1 2 3 4 5 6 Template field Reason for Crosswalk A value of 0 equals Renewing the same product/plan combination using the same 2014 Plan ID; a value of 1 equals Renewing the same product/plan combination using a different 2015 Plan ID; a value of 2 equals Renewing product or renewal in a different plan within the product; a value of 3 equals Continuing product with no plan available in the particular service area under that product and enrollment in a different product; a value of 4 equals Continuing product with no plan available in the particular service area under that product and no enrollment option; a value of 5 equals Discontinuing product and no enrollment option; a value of 6 equals Discontinuing product and enrollment into a different product

PlanID_2015

Fourteen-character alpha-numeric code that identifies the 2015 insurance plan in HIOS Text 2015 Plan ID Free text Template field 2015 HIOS Plan ID (Standard Component) A value of “00000XX0000000” indicates the 2014 plan is not mapped to a 2015 plan for the given county or county-zip code because the product is discontinued and the issuer is not offering auto-enrollment

IssuerID_2015

Five-digit numeric code that identifies the issuer organization in HIOS for the 2015 plan Text 2015 Issuer ID Free text System-generated field Issuer ID 2015 A value of “00000” indicates the 2014 plan is not mapped to a 2015 plan for the given county or county-zip code because the product is discontinued and the issuer is not offering auto-enrollment

MultistatePlan_2015

Categorical indicator of whether the 2015 plan is a multi-state plan Text 2015 Multistate Plan Y N X System-generated field Multistate Plan 2015 A value of X indicates the issuer did not provide a crosswalk plan ID

MetalLevel_2015

Metal level, or coverage category, of the 2015 plan based on its actuarial value Text 2015 Metal Level Platinum Gold Silver Bronze Catastrophic High Low X System-generated field Metal Level 2015 A value of X indicates the issuer did not provide a crosswalk plan ID; values of High and Low are only applicable for dental plans; values other than High and Low are only applicable to medical plans

ChildAdultOnly_2015

The types of child enrollment options for the 2015 plan Text 2015 Child Adult Only 0 1 2 X System-generated field Child Adult Only 2015 A value of 0 means the 2015 plan allows adult-only and child-only enrollment; a value of 1 means the 2015 plan allows only child-only enrollment; a value of 2 means the 2015 plan allows only adult-only enrollment; a value of X indicates the issuer did not provide a crosswalk plan ID

AgeOffPlanID_2015

Fourteen-character alpha-numeric code that identifies the plan available to enrollees who will age-off (i.e., no longer meet the criteria for continued eligibility) the 2014 plan prior to January 1, 2015 Text 2015 Age Off Plan ID Free text Template field 2015 Plan ID for Enrollees Aging Off Catastrophic or Child-Only Plan A value of “00000XX0000000” indicates that the issuer did not provide an age-off plan ID

IssuerID_AgeOff2015

Five-digit numeric code that identifies the issuer organization in HIOS for the 2015 plan identified in the AgeOffPlanID_2015 field Text Issuer ID for 2015 Age Off Plan Free text System-generated field Issuer ID Age Off 2015 A value of “00000” indicates that the issuer did not provide an age-off plan ID

MultistatePlan_AgeOff2015

Categorical indicator of whether the 2015 age off plan is a multi-state plan Text 2015 Age Off Multistate Plan Y N X System-generated field Multistate Plan Age Off 2015 A value of X indicates that the issuer did not provide an age-off plan ID

MetalLevel_AgeOff2015

Metal level of the 2015 age off plan based on its actuarial value Text 2015 Age Off Metal Level Platinum Gold Silver Bronze Catastrophic High Low X System-generated field Metal Level Age Off 2015 A value of X indicates that the issuer did not provide an age-off plan ID; values of High and Low are only applicable for dental plans; values other than High and Low are only applicable to medical plans

ChildAdultOnly_AgeOff2015

The types of child enrollment options for the 2015 age off plan Text 2015 Age Off Child Adult Only 0 1 2 X System-generated field Child Adult Only Age Off 2015 A value of 0 means the 2015 age off plan allows adult-only and child-only enrollment; a value of 1 means the 2015 age off plan allows only child-only enrollment; a value of 2 means the 2015 age off plan allows only adult-only enrollment; a value of X indicates that the issuer did not provide an age-off plan ID

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