Health Insurance Plans Unified Rate Review PUF

$199 / year

The Public Health Service Act (PHSA) and the implementing regulation, establish requirements for health insurance issuers (issuers) offering health insurance coverage for non-grandfathered products in the small group and/or individual markets to submit rate filing information on rate increases to the Centers for Medicare & Medicaid Services (CMS). Rate Filing Justification (RFJ) submissions must provide sufficient information for state or federal regulators to review rate filings. In addition, CMS may use data submitted on the RFJ to calculate Advance Premium Tax Credit (APTC) payments and Cost-Sharing Reduction (CSR) advance payments.

Complexity

The Part I Unified Rate Review template is required to be submitted by all issuers in the individual, small group and/or combined markets that are proposing a rate increase on any single risk pool compliant products. In addition, all issuers applying to offer at least one qualified health plan (QHP) in the state must submit the template for the market in which the QHP would be offered. The template may also be required by regulatory authority for products in the single risk pool. Issuers are required to submit the annual rate change (i.e. January rate changes).

In addition, quarterly rate increases for the small group market are allowed if allowed by the state regulatory authority. All issuers are required to set the Index Rate for an effective date of January 1 of each year, and file the Index Rate with the applicable regulatory authority. Subject to state requirements, small group issuers are allowed to file subsequent submissions that reset the Index Rate for the remaining quarters of the calendar year.

As of September 1, 2011, the Affordable Care Act and rate review regulation require review of rate increases of 10 percent or more. A non-grandfathered health plan sold in the individual or small group market that increases its rates by 10 percent or more is subject to review to determine whether the increase is unreasonable. Most states and territories have an effective rate review program and will review rate increases submitted by health insurance issuers in their states and territories. CMS will review rate increases in the market(s) where states do not have an effective rate review program. Additionally, effective January 1, 2014, all plans compliant with the rate monitoring and single risk pool requirements of the Affordable Care Act are required to submit all plans within the single risk pool.

For individual and small employer plans not subject to the single risk pool, each rate increase subject to review, a health insurance issuer must submit a Preliminary Justification for each product affected by the increase. This Preliminary Justification consists of the following parts: Part I, Rate Increase Summary: A form that summarizes the data used to determine the rate increase.

CCIIO (Center for Consumer Information and Insurance Oversight) is also making the data in this form available on the CCIIO website for public use. Part II, Written Explanation of the Rate Increase: A simple and brief narrative describing the data provided in Part I and the assumptions used to develop the rate increase, including an explanation of the most significant factors causing the rate increase. Part III, Rate Filing Documentation: Rate filing documentation that CMS uses to determine whether the rate increase is unreasonable. This section of the Preliminary Justification is only required to be filed when CMS is conducting the rate review. It is posted on the CCIIO website.

Date Created

2014-08-28

Last Modified

2017-12-12

Version

2017-12-12

Update Frequency

Annual

Temporal Coverage

2014-2015

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Health Insurance, Insurance Marketplace, Rate Review, Insurance Rate Review, Insurance Rate Increase, Insurance Market Competition

Other Titles

Health Insurance Issuers Unified Rate Review PUF 2014-2015, Health Insurance Market place Competition Unified Rate Review PUF 2014-2015, Qualified Health Plan Unified Rate Review PUF 2014-2015

NameDescriptionTypeConstraints
YearYear of datadate-
Company_Legal_NameOrganization’s legal entity name. Name that is associated with the HIOS Issuer IDstring-
HIOS_Issuer_IDHealth Insurance Oversight system Issuer ID assigned to the legal entity.integerlevel : Nominal
Effective_Date_Of_Rate_ChangeThe effective date for which rates are being submitted.date-
Template_IDTemplate ID generated by the systemintegerlevel : Nominal
StateCode for the Statestring-
MarketThe applicable market: Individual, Small Group, or Combined. The market chosen must be consistent with the state’s determination of their allowable markets (e.g. if a state chooses to merge the individual and small group market, the issuer must choose “Combined”).string-
ProductInsurance product. The term “product” is defined as a unique combination of benefits, various cost sharing options and a network design(s) to a particular service area. “Product” has the same meaning as included in 45 CFR Part 154string-
Product_IDInsurance product ID, the product ID that corresponds with each product. The two-letter state code portion of the Product ID must be entered using capital letters. The “Product ID” should be the product number assigned by HIOS.string-
MetalInsurance Metal: For each “plan” within a product, there is a corresponding metal level, Platinum, Gold, Silver, Bronze and Catastrophic. Plans that are included in a QHP certification application must show the same Metal as is shown in the QHP applicationstring-
AV_Metal_ValueThe term “actuarial value” is used to describe a manner of estimating the value of a plan, but not a specific manner. AV Metal Value refers to the federal definition of actuarial value as prescribed in 45 CFR Part 156, §156.20. AV requirements for Platinum hold 90%, Gold hold 80%, Silver 70%, Bronze 60% and Catastrophic: Not specified by lawstring-
AV_Pricing_ValueThe AV Pricing Value represents the cumulative effect of adjustments made by the issuer to move from the Market Adjusted Index Rate to the Plan Adjusted Index Rate. It is likely to have a spread from one plan to another that emulates the spread in the Plan Adjusted Index Rates of the same plans.string-
Plan_TypePlan Types are Indemnity, PPO, POS, HMO or EPO. The term “plan” is defined as a unique combination of benefits to a specific set of cost sharing options and network design(s) to a particular service area.string-
Plan_NameThe name of each plan within a product. The term “plan” is defined as a unique combination of benefits to a specific set of cost sharing options and network design(s) to a particular service area.string-
Plan_ID_Standard_Component_IDAssigned Plan ID. The two-letter state code portion of the Plan ID must be entered using capital letters. The Plan ID is a unique identifier for the set of benefits and cost sharing values offered within a product by the HIOS issuer, or in other words, a unique identifier of each plan. Plan IDs contain three digits. This field must be entered as a text input and must include any leading zeros (e.g. 001).string-
Exchange_PlanExchange plan, is an indicator as to whether the plan will be offered inside a State-based or Federally Facilitated Exchange or Small Business Health Options Program (SHOP), regardless of whether or not it will also be offered in the outside market. If an application for qualified health plan status is pending, it is indicated “yes.” This indicator should not be used to identify whether a plan is offered on a private exchange.numberlevel : Ratio
Historical_Rate_Increase_Calendar_Year_2For each product, the historical rate increase for the period two years prior to the current calendar year.numberlevel : Ratio
Historical_Rate_Increase_Calendar_Year_1For each product, the historical rate increase for the period of one year prior to the current calendar year.numberlevel : Ratio
Historical_Rate_Increase_Calendar_Year_0For each product, the historical rate increase for the current calendar year.numberlevel : Ratio
Effective_Date_Of_Proposed_RateThe corresponding effective date of the proposed rate increases.date-
Rate_Change_In_Percent_Over_Prior_FilingAverage change in premium rates over the rates included in the prior filing for each plan. All products and plans must have the same effective date.string-
Cumulative_Rate_Change_In_Percent_Over_12_Months_PriorThe average change in premium rates over the twelve month period prior to the effective date for each plan. This should be the premium weighted average of the 12-month increases that apply at renewal. For new plans enter -999.00% in this field. It is important to enter this value in the template in this case so other calculated fields in the template are correctly generated.numberlevel : Ratio
Projected_Per_Rate_Change_In_Percent_Over_Experience_PeriodFor each plan, the percentage change in rates between the Experience Period and the Projection Period is shown. This is a calculated field.numberlevel : Ratio
Product_Threshold_Rate_Increase_In_PercentThe template calculates the threshold rate increase for each product. This is the rate increase that determines whether the rate increase is subject to review, per 45 CFR Part 154 §154.200.numberlevel : Ratio
Plan_Rate_Increase_By_InpatientIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product.numberlevel : Ratio
Plan_Rate_Increase_By_OutpatientIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product.numberlevel : Ratio
Plan_Rate_Increase_By_ProfessionalIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_Prescription_DrugIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_OtherIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_CapitationIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_AdministrationIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_Taxes_And_FeesIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Rate_Increase_By_Risk_And_Profit_ChangeIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Total_Rate_IncreaseIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Member_Cost_Share_IncreaseIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Average_Current_Rate_PMPMIs a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.numberlevel : Ratio
Plan_Projected_Member_MonthsThe projected member months by plan that correspond to the effective period of the rates for each plan.numberlevel : Ratio
Base_Period_Average_Rate_PMPMThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The average premium rate PMPM for each plan during the experience period. The average should be generated using membership consistent with the Experience Period for each plan.numberlevel : Ratio
Base_Period_Member_MonthsThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The total member months during the Experience Period should be consistent with the Experience Period Member Months.numberlevel : Ratio
Base_Period_Total_PremiumThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The total premium earned in the Experience Period for each plan is calculated as the Average Rate PMPM multiplied by the Member Months in a given plan.numberlevel : Ratio
Base_Period_EHB_Basis_Or_Full_Portion_Of_TPThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total premium that is associated with EHB services in each plan (including administrative expenses and profit associated with those services).numberlevel : Ratio
Base_Period_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total premium for each plan that is associated with state mandated benefits that are not part of the EHB package.string-
Base_Period_Other_Benefits_Portion_Of_TPThe information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above.string-
Base_Period_Total_Allowed_ClaimsThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The total allowed claims for each benefit plan with service dates within the Experience Period. The Total Allowed Claims (TAC) across all benefit plans for the Experience Period should be consistent with the Allowed Claimsnumberlevel : Ratio
Base_Period_EHB_Basis_Or_Full_Portion_Of_TACThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total allowed claims that are associated with EHB services in each plan during the Experience Period.numberlevel : Ratio
Base_Period_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total allowed claims for each plan that are associated with state mandated benefits that are not part of the EHB package.string-
Base_Period_Other_Benefits_Portion_of_TACThe information shown in this section captures the historical data for the twelve month period used in the base period experience.This is a calculated field which generates the remaining percentage of the total allowed claims based on the values entered from the EHB and state mandated benefits portions. As stated previously, the sum of the EHB portion, the state mandated benefit portion not associated with EHBs and the other benefits portion should equal 100%.string-
Base_Period_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationThe information shown in this section captures the historical data for the twelve month period used in the base period experience.numberlevel : Ratio
Base_Period_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The portion of the total dollars that are attributable to HHS during the Experience Period. This is the cost sharing reduction subsidies.numberlevel : Ratio
Base_Period_Portion_Payable_By_HHS_On_Behalf_Of_Insured_Person_PercentThe information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.numberlevel : Ratio
Base_Period_Total_Incurred_Claims_Payable_With_Issuer_FundsThe information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.numberlevel : Ratio
Base_Period_Net_Amount_Of_ReinsuranceThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The Federal reinsurance amount received for each plan during the Experience Period.numberlevel : Ratio
Base_Period_Net_Amount_Of_Risk_AdjustedThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The risk transfer charge or payment during the Experience Period for each plannumberlevel : Ratio
Base_Period_Incurred_Claims_PMPMThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Base_Period_Allowed_Claims_PMPMThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Base_Period_EHB_Portion_Of_Allowed_Claims_PMPMThe information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Projected_Plan_Adjusted_Index_RateThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Member_MonthsThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state). The template populates the projected Member Months using the Projected Member Months.numberlevel : Ratio
Projected_Total_PremiumThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_EHB_Basis_Or_Full_Portion_Of_TPThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).string-
Projected_Other_Benefits_Portion_Of_TPThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).string-
Projected_Total_Allowed_ClaimsThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_EHB_Basis_Or_Full_Portion_Of_TACThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).string-
Projected_Other_Benefits_Portion_Of_TACThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).string-
Projected_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_PersonThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Total_Incurred_Claims_Payable_with_Issuer_FundsThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state). The portion of the total dollars attributable to HHS during the projection period. This is the cost sharing reduction subsidies.numberlevel : Ratio
Projected_Net_Amount_Of_ReinsuranceThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Net_Amount_Of_Risk_AdjustedThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Incurred_Claims_PMPMThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Projected_Allowed_Claims_PMPMThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Plan_Section_4_Plan_Member_MonthsThe number of member months expected to be coverednumberlevel : Ratio
Projected_EHB_Portion_Of_Allowed_Claims_PMPMThe projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).numberlevel : Ratio
Plan_Section_4_Plan_Adjusted_Index_RateThe Plan Adjusted Index Rate is the Market Adjusted Index Rate further adjusted for plan specific factors allowed by 45 CFR Part 156.80(d)(2) such as provider network, utilization management, benefits in addition to Essential Health Benefits (EHBs), actuarial value and cost sharing, distribution and administrative costs (less Exchange fees) and catastrophic plan eligibility variation.numberlevel : Ratio
Plan_Section_4_Total_PremiumThe total premium earned in the projection period for each plan is calculated as the Average Rate PMPM multiplied by the Member Months in a given plan.numberlevel : Ratio
Plan_Section_4_EHB_Basis_Or_Full_Portion_Of_TPThe percentage of the total premium that is associated with EHB services in each plan (including administrative expenses and profit associated with those services). When calculating the EHB Percent of TP, the Administrative Expense Load, Profit & Risk Load, and Taxes & Fees should be allocated to the various categories in this section (EHB, state mandated benefits that are not EHB, and other benefits) of the template in proportion to the claims expenses.string-
Plan_Section_4_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBThe percentage of the total premium for each plan that is associated with state mandated benefits that are not part of the EHB package.numberlevel : Ratio
Plan_Section_4_Net_Amount_Of_Risk_AdjustedThe amount of any risk transfer payment expected to be received during the projection period for each plan. If a risk transfer charge is anticipated to be assessed, the value entered should be negative.numberlevel : Ratio
Plan_Section_4_Other_Benefits_Portion_Of_TPThis is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above. As stated previously, the sum of the EHB portion, the state mandated benefit portion not associated with EHBs and the other benefits portion should equal 100%.numberlevel : Ratio
Plan_Section_4_Total_Allowed_ClaimsThe total allowed claims for each benefit plan with service dates within the projection periodnumberlevel : Ratio
Plan_Section_4_Net_Amount_Of_ReinsuranceThe Federal reinsurance amount expected to be received for each plan during the projection period, net of the reinsurance assessmentsnumberlevel : Ratio
Plan_Section_4_EHB_Basis_Or_Full_Portion_Of_TACThe percentage of the total allowed claims for each plan that are associated with state mandated benefits that are not part of the EHB package.numberlevel : Ratio
Plan_Section_4_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBThe percentage of the total premium for each plan that is associated with state mandated benefits that are not part of the EHB package. Similar to the EHB percentage, the state mandated benefit percentage of the total premium should include the portion of administrative expenses, taxes and fees and risk and profit loads associated with these services.string-
Plan_Section_4_Total_Incurred_Claims_Payable_With_Issuer_FundsTotal claims incurred payable with issuer fundsnumberlevel : Ratio
Plan_Section_4_Other_Benefits_Portion_Of_TACThis is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above.numberlevel : Ratio
Plan_Section_4_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationAllowed claim which are not the issuers obligationnumberlevel : Ratio
Plan_Sec_4_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonThe portion of the total dollars that are attributable to HHS during the Experience Period. This is the cost sharing reduction subsidies.numberlevel : Ratio
Plan_Sec_4_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_PersonThis is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.numberlevel : Ratio
Plan_Section_4_Incurred_Claims_PMPMThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Plan_Section_4_Plan_Allowed_Claims_PMPMThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Plan_EHB_Portion_Of_Allowed_Claims_PMPMThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Premiums_Net_Of_MLR_Rebate_In_Experience_Period_PMPMThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Experience_Period_Member_MonthsThe total number of months of coverage in the experience period for all members that had coverage during any portion of the Experience Period.numberlevel : Ratio
Premiums_Net_Of_MLR_Rebate_In_Experience_Period_Claims_AmountThe amount of premium earned during the Experience Period, net of rebates to policyholders on an incurred basis due to the medical loss ratio (MLR) requirements as defined in 45 CFR § 158.numberlevel : Ratio
Allowed_Claims_AmountThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Incurred_Claims_Amount_In_Experience_PeriodTotal claims incurred in the Experience Period.numberlevel : Ratio
Incurred_Claims_In_Experience_Period_PMPMPMPM incurred claims amount in the experience periodnumberlevel : Ratio
Allowed_Claims_PMPMThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Single_Risk_Pool_Gross_Premium_Average_Rate_PMPMThe issuer is required to provide support that the single risk pool in a particular state and market is established according to the requirements in 45 CFR § 156.80(d).numberlevel : Ratio
Projected_Member_Month_Projected_ExperienceThe number of member months expected to be covered during the Projection Period.numberlevel : Ratio
Single_Risk_Pool_Gross_Premium_Avg_Rate_PMPM_Projected_Period_TotalsThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Projected_Incurred_Claims_Projected_Period_TotalsThe template calculates aggregate dollar amounts for Section III PMPM values entered into or calculated by the template. The amounts are calculated by multiplying the Projected Member Months by the applicable PMPM value.numberlevel : Ratio
Projected_ACA_Reinsurance_Recoveries_Net_Of_Reinsurance_Premium_PMPMProjected reinsurance recoveries, referred to as reinsurance payments in the HHS Notice of Benefit and Payment Parameters, from the Federal reinsurance program, less contributions made to the program (referred to as “Premium” in the template).numberlevel : Ratio
Projected_Incurred_ClaimsThe template calculates this value by subtracting the Projected Risk Adjustments, PMPM from the Projected Incurred Claims, before ACA rein & Risk Adj’t, PMPM.numberlevel : Ratio
Projected_Allowed_Experience_Claims_PMPM_Applied_CredibilityThe Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.numberlevel : Ratio
Index_Rate_For_Projection_PeriodThe projected Index Ratenumberlevel : Ratio
Plan_Product_Submission_Tracking_NumberTracking number for the rate review submissionstring-
System_Generated_MIDAS_Load_DateSystem Generated load datedate-
Status_Change_DateSystem Generated status change datestring-
Submission_Status_DescriptionRate review submission status descriptionstring-
Submission_TypeSubmission typestring-
Final_DeterminationFinal determinationstring-
Insurance_Product_Rate_JustificationReason for rate reviewstring-
YearCompany_Legal_NameHIOS_Issuer_IDEffective_Date_Of_Rate_ChangeTemplate_IDStateMarketProductProduct_IDMetalAV_Metal_ValueAV_Pricing_ValuePlan_TypePlan_NamePlan_ID_Standard_Component_IDExchange_PlanHistorical_Rate_Increase_Calendar_Year_2Historical_Rate_Increase_Calendar_Year_1Historical_Rate_Increase_Calendar_Year_0Effective_Date_Of_Proposed_RateRate_Change_In_Percent_Over_Prior_FilingCumulative_Rate_Change_In_Percent_Over_12_Months_PriorProjected_Per_Rate_Change_In_Percent_Over_Experience_PeriodProduct_Threshold_Rate_Increase_In_PercentPlan_Rate_Increase_By_InpatientPlan_Rate_Increase_By_OutpatientPlan_Rate_Increase_By_ProfessionalPlan_Rate_Increase_By_Prescription_DrugPlan_Rate_Increase_By_OtherPlan_Rate_Increase_By_CapitationPlan_Rate_Increase_By_AdministrationPlan_Rate_Increase_By_Taxes_And_FeesPlan_Rate_Increase_By_Risk_And_Profit_ChangePlan_Total_Rate_IncreasePlan_Member_Cost_Share_IncreasePlan_Average_Current_Rate_PMPMPlan_Projected_Member_MonthsBase_Period_Average_Rate_PMPMBase_Period_Member_MonthsBase_Period_Total_PremiumBase_Period_EHB_Basis_Or_Full_Portion_Of_TPBase_Period_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBBase_Period_Other_Benefits_Portion_Of_TPBase_Period_Total_Allowed_ClaimsBase_Period_EHB_Basis_Or_Full_Portion_Of_TACBase_Period_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBBase_Period_Other_Benefits_Portion_of_TACBase_Period_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationBase_Period_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonBase_Period_Portion_Payable_By_HHS_On_Behalf_Of_Insured_Person_PercentBase_Period_Total_Incurred_Claims_Payable_With_Issuer_FundsBase_Period_Net_Amount_Of_ReinsuranceBase_Period_Net_Amount_Of_Risk_AdjustedBase_Period_Incurred_Claims_PMPMBase_Period_Allowed_Claims_PMPMBase_Period_EHB_Portion_Of_Allowed_Claims_PMPMProjected_Plan_Adjusted_Index_RateProjected_Member_MonthsProjected_Total_PremiumProjected_EHB_Basis_Or_Full_Portion_Of_TPProjected_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBProjected_Other_Benefits_Portion_Of_TPProjected_Total_Allowed_ClaimsProjected_EHB_Basis_Or_Full_Portion_Of_TACProjected_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBProjected_Other_Benefits_Portion_Of_TACProjected_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationProjected_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonProjected_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_PersonProjected_Total_Incurred_Claims_Payable_with_Issuer_FundsProjected_Net_Amount_Of_ReinsuranceProjected_Net_Amount_Of_Risk_AdjustedProjected_Incurred_Claims_PMPMProjected_Allowed_Claims_PMPMPlan_Section_4_Plan_Member_MonthsProjected_EHB_Portion_Of_Allowed_Claims_PMPMPlan_Section_4_Plan_Adjusted_Index_RatePlan_Section_4_Total_PremiumPlan_Section_4_EHB_Basis_Or_Full_Portion_Of_TPPlan_Section_4_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHBPlan_Section_4_Net_Amount_Of_Risk_AdjustedPlan_Section_4_Other_Benefits_Portion_Of_TPPlan_Section_4_Total_Allowed_ClaimsPlan_Section_4_Net_Amount_Of_ReinsurancePlan_Section_4_EHB_Basis_Or_Full_Portion_Of_TACPlan_Section_4_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHBPlan_Section_4_Total_Incurred_Claims_Payable_With_Issuer_FundsPlan_Section_4_Other_Benefits_Portion_Of_TACPlan_Section_4_Allowed_Claims_Which_Are_Not_The_Issuers_ObligationPlan_Sec_4_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_PersonPlan_Sec_4_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_PersonPlan_Section_4_Incurred_Claims_PMPMPlan_Section_4_Plan_Allowed_Claims_PMPMPlan_EHB_Portion_Of_Allowed_Claims_PMPMPremiums_Net_Of_MLR_Rebate_In_Experience_Period_PMPMExperience_Period_Member_MonthsPremiums_Net_Of_MLR_Rebate_In_Experience_Period_Claims_AmountAllowed_Claims_AmountIncurred_Claims_Amount_In_Experience_PeriodIncurred_Claims_In_Experience_Period_PMPMAllowed_Claims_PMPMSingle_Risk_Pool_Gross_Premium_Average_Rate_PMPMProjected_Member_Month_Projected_ExperienceSingle_Risk_Pool_Gross_Premium_Avg_Rate_PMPM_Projected_Period_TotalsProjected_Incurred_Claims_Projected_Period_TotalsProjected_ACA_Reinsurance_Recoveries_Net_Of_Reinsurance_Premium_PMPMProjected_Incurred_ClaimsProjected_Allowed_Experience_Claims_PMPM_Applied_CredibilityIndex_Rate_For_Projection_PeriodPlan_Product_Submission_Tracking_NumberSystem_Generated_MIDAS_Load_DateStatus_Change_DateSubmission_Status_DescriptionSubmission_TypeFinal_DeterminationInsurance_Product_Rate_Justification
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.780.824PPOE672487NC001003000002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.790.824PPOE872487NC001003200002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7980.824PPOE172487NC001002500002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7870.824PPOE272487NC001002600002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7890.824PPOE372487NC001002700002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7840.824PPOE472487NC001002800002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7860.824PPOE572487NC001002900002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.7840.824PPOE772487NC001003100002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Bronze0.60.605PPOG872487NC001004000002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual
2014All Savers Insurance Company724872014-01-01261373NCSmall GroupAll Savers Group72487NC001Gold0.8090.841PPOJ172487NC001005700002014-01-010-9.99990.00000000000000000000000000000000000000000000000000000000.0000000000000000000.000000000001000001000.000000000000000000000400.820462242494706.2041968323.1950316.2473446.677439.8472487-21912014-08-272014-05-09Rate Filing AcceptedAnnual