Health Insurance Plan Level Individual Rates PUF

$716 / year

This dataset contains the Rate Public Use File (PUF) that makes up the Marketplace Public Use Files. The Rate-PUF contains plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.

Complexity

The market reforms provide new rating parameters for health insurance premiums; extend guaranteed availability protections to the individual market; continue current guaranteed renewability protections; prohibit health insurance issuers from dividing up their insurance pools; clarify the approach used to enforce the applicable requirements of the Affordable Care Act with respect to issuers and group health plans that are non-federal governmental plans; and provide standards regarding catastrophic plans. The market rules collectively ensure that individuals and employers will have a minimum set of protections with respect to access to health insurance coverage and greater premium stability in all States, both inside and outside Exchanges.

The final rule directs issuers offering non-grandfathered health insurance coverage in the individual and small group markets for plan or policy years starting in 2014, and the large group market if such coverage is available through an Exchange starting in 2017, to limit any variation in premiums with respect to a particular plan or coverage to variations based on age, tobacco use (subject to wellness program requirements in the small group market), family size, and geography. The final rule prohibits the use of other rating factors such as health status, medical history, gender, and industry of employment to set premium rates. Under the final rule, the age, tobacco use, and geography factors are multiplicative. For example, under this approach, the oldest adult who uses tobacco may be charged up to 4.5 times more than the youngest adult who does not use tobacco since the age and tobacco use factors would be multiplied (3 x 1.5). Family premiums generally would be determined by adding up the premiums of each family member. While this rule establishes a federal floor that ensures all individuals and employers have certain basic protections with respect to the availability of the health insurance coverage in all states, this rule does not prevent states from enacting stronger consumer protections than these minimum standards.

In Fair Health Insurance Premiums
– Age Rating: Rates can vary within a ratio of 3:1, States can establish age curves or can default to federal age curve, Proposed age bands: 0-20; one-year bands between 21-63; 64 and older
– Tobacco Rating: Rates can vary within 1.5:1 ratio, Can vary based on age (e.g., 1.2:1 for those under 35), For small employers, individuals must be able to avoid the tobacco surcharge by participating in a wellness program that complies with section 2705(j) of the PHS Act
– Geography: States would establish rating areas within 30 days of publication of the final rule, Proposed geographic standards:

– One rating area for the entire state or
– No more than 7 rating areas based on counties, zip codes or metropolitan statistical areas (MSAs); default would be either one area for entire State or CMS would establish areas on the above bases
– Family Size: PHS Act §2701(a)(4) requires that rating variation permitted for age and tobacco use can only be applied based on the portion of premium attributed to the individual family member, Per-member rating would be required except States with pure community rating could elect to establish family tiers, Cap of 3 for family members under the age of 21 that are rated
– Rating in the Small Group Market: Per-member rating is proposed, Per-member rating supports the accuracy of risk adjustments, Employers and States could still elect to require composite/average premiums for employer groups.

The proposed Rate Review regulation would ensure rate increases and other rating requirements are consistently monitored inside and outside of an Exchange, add a 0% reporting threshold for any increase above zero percent and maintains a 10% review threshold to evaluate the reasonableness of the proposed increase, direct issuers to use of a new unified rate review template that can be used by states and multiple groups within CCIIO for rate review, monitoring new rating reforms, and market-wide financial management and update the requirements to have an Effective Rate Review Program to include reviewing the rate impact of federal reinsurance, risk adjustment, and other market reforms. These data either originate from the Rate Table template, an Excel based form used by issuers to describe their plans in the Qualified Health Plan (QHP)/ Stand Alone Dental Plans (SADP) application process, or were generated by Center for Consumer Information and Insurance Oversight (CCIIO) for use in data processing.

Date Created

2014-12-23

Last Modified

2018-04-06

Version

2018-04-06

Update Frequency

Annual

Temporal Coverage

2014-2018

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 Rates, Health Insurance, Insurance Marketplace, Rate Review, Insurance Rate Review

Other Titles

Health Insurance Rate By Plan Level Age Tobacco Use And Location PUF 2014-2018, Health Insurance Market place Rate Review PUF 2014-2018, Health Plan Rate Review PUF Plan Level Age Tobacco Use And Location 2014-2018

NameDescriptionTypeConstraints
Business_YearYear for which plan provides coverage to enrolleesdate-
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 import. Health Insurance Oversight System(HIOS), System for electronic rates and forms filing (SERFF), Office of Personnel Management (OPM)string-
Version_NumberInteger value for version of data importintegerlevel : Nominal
Import_DateDate of data importdate-
Federal_TINTax ID Number of issuerstring-
Rate_Effective_DateDate that the foundation insurance plan base rate started being used to determine the federally facilitated exchange rate for a specific insurance plandate-
Rate_Expiration_DateDate that the foundation insurance plan base rate stopped being used to determine the federally facilitated exchange rate for a specific insurance plandate-
Plan_IdFourteen-character alpha-numeric code that identifies an insurance plan within HIOSstring-
Rating_Area_IdIdentifier for the geographic rating area within a stateintegerlevel : Nominal
Tobacco_Use_IndicatorCategorical indicator of whether a subscriber's tobacco use is used to determine rate eligibility for the insurance planstring-
Age_Use_IndicatorCategorical indicator of whether a subscriber's age is used to determine rate eligibility for the insurance planstring-
Individual_RateDollar 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 preferencenumber-
Individual_Tobacco_RateDollar value for the insurance premium cost applicable to a tobacco user for the insurance plan in a rating areanumber-
Couple_RateDollar value for the insurance premium cost applicable to the primary enrollee plus a secondary subscriber for the insurance plan in a rating areanumber-
Primary_Subscriber_And_One_Dependent_RateDollar value for the insurance premium cost applicable to the primary enrollee plus one dependent for the insurance plan in a rating areanumber-
Primary_Subscriber_And_Two_Dependents_RateDollar value for the insurance premium cost applicable to the primary enrollee plus two dependents for the insurance plan in a rating areanumber-
Primary_Subscriber_And_Three_Or_More_Dependents_RateDollar value for the insurance premium cost applicable to the primary enrollee plus three or more dependents for the insurance plan in a rating areanumber-
Couple_And_One_Dependent_RateDollar 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 areanumber-
Couple_And_Two_Dependents_RateDollar 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 areanumber-
Couple_And_Three_Or_More_Dependents_RateDollar 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 areanumber-
Row_NumberInteger value for template row number associated with this data recordnumberlevel : Ratio
Business_YearState_AbbreviationIssuer_IdSource_NameVersion_NumberImport_DateFederal_TINRate_Effective_DateRate_Expiration_DatePlan_IdRating_Area_IdTobacco_Use_IndicatorAge_Use_IndicatorIndividual_RateIndividual_Tobacco_RateCouple_RatePrimary_Subscriber_And_One_Dependent_RatePrimary_Subscriber_And_Two_Dependents_RatePrimary_Subscriber_And_Three_Or_More_Dependents_RateCouple_And_One_Dependent_RateCouple_And_Two_Dependents_RateCouple_And_Three_Or_More_Dependents_RateRow_Number
2018
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference19
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference20
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference21
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference22
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference23
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference24
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference25
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference26
2018AL82285HIOS2017-08-1294-27615372018-01-012018-12-3182285AL00100011No Preference27