Health Insurance Business Rules PUF

$179 / year

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).

Complexity

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).

Date Created

2014-11-26

Last Modified

2019-04-25

Version

2019-04-25

Update Frequency

Annual

Temporal Coverage

2019

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

NameDescriptionTypeConstraints
State_AbbreviationTwo-character state abbreviation indicating the state where the plan is offeredstring-
Issuer_IdFive-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS)integerlevel : Nominal
Source_NameCategorical identifier of source of data importstring-
Import_DateDate when data was importeddatetime-
TINTax ID Number of issuerstring-
Product_IdTen-character alpha-numeric code that identifies an insurance product within HIOSstring-
Standard_Component_IdFourteen-character alpha-numeric code that identifies an insurance plan within HIOSstring-
Enrollee_Contract_Rate_Determination_RuleDescription of enrollee contract rule for determining ratesstring-
Two_Parent_Family_Max_Dependents_RuleThe maximum number of dependents used to rate a policy in a two-parent familystring-
Single_Parent_Family_Max_Dependents_RuleThe maximum number of dependents used to rate a policy in the single parent familystring-
Dependent_Maximum_Age_RuleInteger value for the maximum age for which an insurance plan could be issued for a child, if applicableintegerlevel : Nominal
Children_Only_Contract_Max_Children_RuleThe maximum number of children used to rate a child-only policystring-
Is_Domestic_Partner_As_Spouse_IndicatorCategorical indicator for whether a domestic partner is treated the same as secondary subscribersboolean-
Is_Same_Sex_Partner_As_Spouse_IndicatorCategorical indicator for whether a same-sex partner is treated the same as secondary subscribersboolean-
Age_Determination_RuleCategorical indicator for the method used to determine the person's age at the time of an applicationstring-
Minimum_Tobacco_Free_Months_RuleInteger value for the number of tobacco-free months considered when qualifying an enrollee for the non-tobacco insurance rate, if applicableintegerlevel : Nominal
Cohabitation_RuleCategorical indicator that identifies which family relationships are allowed for enrollees and whether cohabitation is requiredstring-
Market_CoverageCategorical indicator of market coverage of plans submitted with this templatestring-
Is_Dental_Only_PlanCategorical indicator that plan is a stand-alone dental planboolean-
State_AbbreviationIssuer_IdSource_NameImport_DateTINProduct_IdStandard_Component_IdEnrollee_Contract_Rate_Determination_RuleTwo_Parent_Family_Max_Dependents_RuleSingle_Parent_Family_Max_Dependents_RuleDependent_Maximum_Age_RuleChildren_Only_Contract_Max_Children_RuleIs_Domestic_Partner_As_Spouse_IndicatorIs_Same_Sex_Partner_As_Spouse_IndicatorAge_Determination_RuleMinimum_Tobacco_Free_Months_RuleCohabitation_RuleMarket_CoverageIs_Dental_Only_Plan
FL93299HIOS2018-08-21T03:20:0045-254815893299FL00193299FL0010001A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,YesIndividualtrue
DE67775SERFF2018-07-24T20:18:0054-180829267775DE00167775DE0010003A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,NoIndividualtrue
DE67775SERFF2018-07-24T20:18:0054-180829267775DE00167775DE0010005A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,NoIndividualtrue
DE67775SERFF2018-07-24T20:18:0054-180829267775DE00267775DE0020003A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,NoIndividualtrue
DE67775SERFF2018-07-24T20:18:0054-180829267775DE00267775DE0020005A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,NoIndividualtrue
NJ52095SERFF2018-08-22T20:18:0022-232122652095NJ00152095NJ0010001A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more213 or moretruetrueAge on effective dateSelf,YesIndividualtrue
HI18350SERFF2018-11-26T20:15:0099-004011518350HI08818350HI0880003A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more3 or morefalsefalseAge on effective date6Self,YesIndividualfalse
IN79503HIOS2018-07-16T02:09:0031-118526279503IN00179503IN0010001A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more252falsetrueAge on effective dateBrother or Sister,NoIndividualtrue
IN79503HIOS2018-07-16T02:09:0031-118526279503IN00179503IN0010002A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more252falsetrueAge on effective dateBrother or Sister,NoIndividualtrue
MI23426SERFF2018-08-20T20:18:0031-118526223426MI00123426MI0010001A different rate (specifically for parties of two or more)for each enrollee is added together3 or more3 or more252falsetrueAge on effective dateBrother or Sister,NoIndividualtrue