Others titles
- Health Insurance Exchange Public Use Files
- Qualified Health Plan Business Rules PUF
Keywords
- Health Insurance
- Insurance Marketplace
- Business Rules
- Insurance Rate Review
- Insurance Rate Increase
- Insurance Market Competition
- Health Benefits
- Benefits and Cost Sharing
- Benefits and Cost Sharing PUF
- Exchange PUFs
Health Insurance Business Rules PUF
This dataset shows the plan-level data on rating business rules, such as allowed relationships (e.g., spouse, dependents) and tobacco use by the Centers for Medicare & Medicaid Services (CMS).
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Description
The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is releasing the State-Based Marketplace (SBM) Public Use Files (PUF) to improve the transparency and increase access to the SBM data. The SBM PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states that operate their own Marketplaces that do not rely on the federal information technology platform for QHP eligibility and enrollment functionality. This includes states that operate their own Small Business Health Options Programs (SHOPs).
The Business Rules PUF (BR-PUF) is one of the six files that make up the SBM PUF. The BR-PUF contains plan-level data on how rates are applied depending on allowed relationships (e.g., spouse, dependents) and tobacco use.
These data 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, and were provided by the National Association of Insurance Commissioners (NAIC) by extracting the information from its System for Electronic Rate and Form Filing (SERFF).
About this Dataset
Data Info
Date Created | 2014-11-26 |
---|---|
Last Modified | 2024-02-06 |
Version | 2024-02-06 |
Update Frequency |
Annual |
Temporal Coverage |
2024 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Health Insurance, Insurance Marketplace, Business Rules, Insurance Rate Review, Insurance Rate Increase, Insurance Market Competition, Health Benefits, Benefits and Cost Sharing, Benefits and Cost Sharing PUF, Exchange PUFs |
Other Titles | Health Insurance Exchange Public Use Files, Qualified Health Plan Business Rules PUF |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
State_Abbreviation | Two-character state abbreviation indicating the state where the plan is offered | string | - |
Issuer_Id | Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) | integer | level : Nominal |
Source_Name | Categorical identifier of source of data import | string | - |
Import_Date | Date when data was imported | date | - |
Medical_Dental_Both | Plan (Dental, Medical or Both) | string | - |
Product_Id | Ten-character alpha-numeric code that identifies an insurance product within HIOS | string | - |
Standard_Component_Id | Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS | string | - |
Medical_Dental_Indicator | Medical or dental indicator | string | - |
Maximum_Underage_Dependent | The maximum number of dependents used to rate a policy | string | - |
Dependent_Maximum_Age_Rule | Integer value for the maximum age for which an insurance plan could be issued for a child, if applicable | integer | level : Nominal |
Age_Determination_Rule | Categorical indicator for the method used to determine the person's age at the time of an application | string | - |
Minimum_Tobacco_Free_Months_Rule | Integer value for the number of tobacco-free months considered when qualifying an enrollee for the non-tobacco insurance rate, if applicable | integer | level : Nominal |
Cohabitation_Rule | Categorical indicator that identifies which family relationships are allowed for enrollees and whether cohabitation is required | string | - |
Market_Coverage | Categorical indicator of market coverage of plans submitted with this template | string | - |
Is_Dental_Only_Plan | Categorical indicator that plan is a stand-alone dental plan | boolean | - |
Data Preview
State Abbreviation | Issuer Id | Source Name | Import Date | Medical Dental Both | Product Id | Standard Component Id | Medical Dental Indicator | Maximum Underage Dependent | Dependent Maximum Age Rule | Age Determination Rule | Minimum Tobacco Free Months Rule | Cohabitation Rule | Market Coverage | Is Dental Only Plan |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK003 | 21989AK0030001 | Dental | 3 | 25 | Age on effective date | Child,No;Foster Child,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | Individual | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK005 | 21989AK0050001 | Dental | 3 | 25 | Age on effective date | Child,No;Foster Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | Individual | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK005 | 21989AK0050002 | Dental | 3 | 25 | Age on effective date | Child,No;Foster Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | Individual | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK007 | 21989AK0070001 | Dental | 3 | 25 | Age on effective date | Child,No;Foster Child,No;Grandson or Granddaughter,No;Self,Yes;Stepson or Stepdaughter,No;Ward,No | Individual | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK008 | 21989AK0080001 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK008 | 21989AK0080002 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK008 | 21989AK0080003 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK008 | 21989AK0080004 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK008 | 21989AK0080005 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True | |
AK | 21989 | HIOS | 2023-12-08 | Dental | 21989AK010 | 21989AK0100001 | Dental | 3 | 25 | Age on effective date | Child,No;Grandson or Granddaughter,No;Life Partner,Yes;Self,Yes;Spouse,No;Stepson or Stepdaughter,No;Ward,No | SHOP (Small Group) | True |