The Center for Consumer Information & Insurance Oversight Plan Attributes Public Use File Data Dictionary

Transcription

1 CMS Center for Consumer Information & Insurance Oversight (CCIIO), Health Insurance Marketplace Public Use Files (Marketplace PUFs) Data Dictionary for Plan Attributes PUF 1. Overview of the Plan Attributes PUF The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) is releasing the Marketplace PUFs in order to improve transparency and increase access to the Marketplace data. The Marketplace PUFs include 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 that rely on the federal information technology platform for QHP eligibility and enrollment functionality (SBM-FP). The Marketplace PUFs also include data on Multi State Plans (MSPs). The Marketplace PUFs do 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 files that make up the Marketplace PUFs. 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, plan year 2015, plan year 2016, and plan year Attributes BusinessYear Year for which plan provides coverage to enrollees Business Year System-generated field Data Business Year 1

2 N/A StateCode Two-character state abbreviation indicating the state where the plan is offered State Code All 50 state abbreviations + 9 territory abbreviations System-generated field Data State Code N/A Data IssuerId Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Issuer ID Free text System-generated field Issuer ID N/A SourceName Categorical identifier of source of data import Source Name HIOS SERFF OPM System-generated field Data Source Name N/A VersionNum Integer value for version of data import Version Number Free text System-generated field Data Version Number 2

3 This field is only available for the 2014, 2015, and 2016 datasets. ImportDate Date of data import Date/Time Import Date Label: Allowable Free text Values: System-generated field Field Name Import Date from Data N/A Name: Definition: BenefitPackageId Numeric identifier of benefit package Benefit Package ID Label: Allowable Free text Values: Data System-generated field Field Name Benefit Package ID from Data This field is only available for the 2014, 2015, and 2016 datasets. IssuerId2 Name: Five-digit numeric code that identifies the issuer organization in Definition: HIOS Issuer ID Label: Allowable Free text Values: Data Field Name HIOS Issuer ID from Data Equal to IssuerId field. This field is only available for the 2014, 2015, and 2016 datasets. 3

4 StateCode2 Name: Two-character state abbreviation indicating the state where the Definition: plan is offered State Code Label: Allowable All 50 state abbreviations + 9 territory abbreviations Values: Data Field Name Issuer State from Data Equal to StateCode field. This field is only available for the 2014, 2015, and 2016 datasets. MarketCoverage Name: Categorical indicator of market coverage of plan Definition: Market Coverage Label: Allowable Individual Values: SHOP (Small Group) Field Name Market Coverage from Data N/A Name: Definition: DentalOnlyPlan Categorical indicator of dental-only status of plan Dental-Only Plan Indicator Label: Allowable Yes Values: No Data Field Name Dental Only Plan from Data N/A 4

5 TIN Name: Tax ID Number of issuer Definition: Tax Identification Number Label: Allowable Free text Values: Data Field Name TIN from Data N/A StandardComponentId Name: Fourteen-character alpha-numeric code that identifies an Definition: insurance plan within HIOS Plan ID Label: Allowable Free text Values: Data Field Name HIOS Plan ID (Standard Component) from Data N/A PlanMarketingName Name: Marketing name of insurance plan Definition: Plan Marketing Name Label: Allowable Free text Values: Data Field Name Plan Marketing Name from Data 5

6 N/A The Center for Consumer Information & Insurance Oversight HIOSProductId Seven- character alpha-numeric code that identifies an insurance product within HIOS HIOS Product ID Free text HIOS Product ID N/A HPID Identifies the insurance product using a National Health Plan Identifier HPID (National Health Plan Identifier) Free text HPID This field is optional; blanks indicate a value was not provided NetworkId Identifier for a health care provider network organization Network ID List of Network IDs valid for the issuer 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 Service Area ID List of Service Area IDs valid for the issuer Service Area ID 6

7 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 Formulary ID List of Formulary IDs valid for the issuer 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 New/Existing Plan New Existing New/Existing Plan N/A PlanType Type of insurance plan Plan Type Indemnity PPO HMO POS EPO Plan Type N/A 7

8 MetalLevel Metal level, or coverage category, of insurance plan based on its actuarial value Metal Level 8

9 Platinum Gold Silver Bronze Catastrophic High Low 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 DesignType An indication that the plan follows a standardized plan design for its metal level. Design Type Design Type 1 Design Type 2 Design Type 3 Design Type 4 Design Type 5 Design Type This field is not available for the 2014, 2015, or 2016 datasets. UniquePlanDesign An indication that the health insurance plan has a unique design, for purposes of the actuarial value calculator Unique Plan Design Yes No 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) 9

10 QHP/Non QHP On Exchange Off Exchange Both Field Name QHP/Non QHP from Data N/A Name: Definition: IsNoticeRequiredForPregnancy An indication of whether notice to the issuer is required before pregnancy-related benefits will be covered Notice Required for Pregnancy Label: Allowable Yes Values: No Data Field Notice Required for Pregnancy Name from Data This field is not applicable for dental plans IsReferralRequiredForSpecialist Name: An indication of whether pre-authorization is required before a Definition: specialist visit Is a Referral Required for Specialist? Label: Allowable Yes Values: No Data Field Is a Referral Required for Specialist? Name from Data This field is not applicable for dental plans 10

11 SpecialistRequiringReferral Name: The types of specialists that require pre-authorization Definition: Specialist Requiring a Referral Label: Allowable Free text Values: Data Field Specialist Requiring a Referral Name from Data 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 Plan Level Exclusions Free text Field Name Plan Level Exclusions from Data This field is optional; blanks indicate a value was not provided Name: Definition: IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee Estimated dollar amount of cost sharing reductions for eligible enrollees to be provided in the form of an advance payment to the issuer Limited Cost Sharing Plan Variation - Estimated Advanced Payment Label: Allowable Free text Values: Field Name Limited Cost Sharing Plan Variation - Est Advanced Payment from Data This field is not applicable for dental plans; this field should be blank for medical plans CompositeRatingOffered 11

12 Name: An indication of whether issuers and employers can use the Definition: composite premium field. Composite Rating Offered Label: Allowable Yes Values: No Field Name Does this plan offer Composite Rating? from Data This field is not available for the 2014 or 2015 datasets. This field will equal No for individual market plans Name: Definition: Label: Allowable Values: ChildOnlyOffering The types of child enrollment options (Allows Adult and Child-only, Allows Adult-only, Allows Child-only) of an insurance plan Child-Only Offering Allows Adult and Child-Only Allows Adult-Only Allows Child-Only Field Name Child-Only Offering from Data This field is not applicable for catastrophic plans 12

13 ChildOnlyPlanId The HIOS Plan Identifier for the child-only insurance plan that corresponds to this insurance plan Child Only Plan ID Free text Child Only Plan ID This field is only applicable for adult-only plans and does not apply to catastrophic plans WellnessProgramOffered An indication of whether an insurance plan offers wellness programs according to Section 2705 of the Public Health Service Act Wellness Program Offered Yes No 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 Disease Management Programs Offered Asthma Heart disease Depression Diabetes High blood pressure & high cholesterol Low back pain Pain management Pregnancy Weight loss programs Disease Management Programs Offered 13

14 This field is not applicable for dental plans EHBPercentTotalPremium The percent of the plan s total premium relative to the EHB benchmark plan for the state. EHB Percent of Total Premium 0-1, blank EHB Percent of Total Premium This field is not available for the 2014 dataset. In the 2015 dataset, this field name is EHBPercentPremiumS4. This field is only valid for medical plans and is not required for catastrophic plans. EHBPediatricDentalApportionmentQuantity The dollar amount or percentage of the EHB Apportionment for Pediatric Dental EHB Apportionment for Pediatric Dental Free text Data EHB Apportionment for Pediatric Dental This field is not applicable for medical plans. This field is a dollar amount for the 2014, 2015, and 2016 datasets and a percentage for the 2017 dataset. Data IsGuaranteedRate An indication of whether the rates for the insurance plan are guaranteed or estimated Guaranteed Rate Guaranteed Rate Estimated Rate Guaranteed vs. Estimated Rate 14

15 This field is not applicable for medical plans Data Data PlanEffictiveDate The activation date of enrollment coverage on an Insurance plan Date Plan Effective Date Free text Plan Effective Date N/A PlanExpirationDate The end date of plan selection for enrollment on an Insurance plan Date Plan Expiration Date Free text 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 Out of Country Coverage Yes No Out of Country Coverage N/A OutOfCountryCoverageDescription The conditions under which out of country health services are covered 15

16 Out of Country Coverage Description Free text Data Out of Country Coverage Description This field is only applicable for plans that offer out of country coverage Data OutOfServiceAreaCoverage Indicates whether out of service area coverage is provided Out of Service Area Coverage Yes No Out of Service Area Coverage N/A OutOfServiceAreaCoverageDescription The conditions under which out of service area health services are covered 16

17 The Center for Consumer Information & Insurance Oversight Out of Service Area Coverage Description Free text Out of Service Area Coverage Description Data 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 National Network Yes No National Network N/A URLForEnrollmentPayment The URL for Enrollment Payment URL for Enrollment Payment Free text Data URL for Enrollment Payment This field is optional, so blanks or zero values indicate a value was not provided FormularyURL The URL for the prescription drug formulary associated with this plan Formulary URL Free text Data Formulary URL This field is not available for the 2014 dataset. This field is only valid for medical plans 17

18 PlanId Seventeen-character alpha-numeric code that identifies an insurance plan s cost sharing reduction (CSR) variant within HIOS Plan ID (Standard Component ID with Variant) Free text Data HIOS Plan ID (Standard Component + Variant) Prepopulated in template; character count includes - Data PlanVariantMarketingName Marketing name of the plan variation of the insurance plan Plan Variant Marketing Name Free text Plan Variant Marketing Name This field is only available for the 2017 dataset. CSRVariationType Name of the cost sharing reduction options offered for a health insurance plan 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 Data 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 18

19 Data Issuer Actuarial Value This field is only applicable for dental plans and plans with a unique plan design AVCalculatorOutputNumber Definition: The numeric AV generated by the template s AV Calculator for an insurance plan AV Calculator Output Number Free text AV Calculator Output Number This field is only applicable for medical plans and plans that do not have a unique plan design Definition: MedicalDrugDeductiblesIntegrated An indication of whether the insurance plan specifies that the medical and drug deductibles are combined into one deductible Medical Drug Deductibles Integrated Yes No Medical & Drug Deductibles Integrated? This field is not applicable for dental plans Definition: 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 Medical Drug Maximum Out of Pocket Integrated Yes No Medical & Drug Maximum Out of Pocket Integrated? This field is not applicable for dental plans MultipleInNetworkTiers 19

20 An indication of whether there are two in network tiers Definition: Multiple In Network Tiers Yes No Multiple In Network Tiers? N/A Definition: FirstTierUtilization The expected percentage of utilization for the first in network tier First Tier Utilization Free text 1st Tier Utilization N/A SecondTierUtilization Definition: The expected percentage of utilization for the second in network tier, based on the value entered for the first tier Second Tier Utilization 100% minus First Tier Utilization 2nd Tier Utilization Calculated by template SBCHavingaBabyDeductible Definition: The dollar amount of the deductible for the sample Summary of Benefits & Coverage (SBC) scenario of having a baby SBC Scenario, Having a Baby, Deductible Free text 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 20

21 SBCHavingaBabyCopayment Definition: The dollar amount of the copayment for the sample SBC scenario of having a baby SBC Scenario, Having a Baby, Copayment Free text 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 SBC Scenario, Having a Baby, Coinsurance Free text 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 SBC Scenario, Having a Baby, Limit Free text 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 SBC Scenario, Having Diabetes, Deductible Free text 21

22 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 SBC Scenario, Having Diabetes, Copayment Free text 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 SBC Scenario, Having Diabetes, Coinsurance Free text Data SBC Scenario, Having Diabetes, Coinsurance This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans Data SBCHavingDiabetesLimit The dollar amount of the benefit limits or exclusions for the sample SBC scenario of having diabetes SBC Scenario, Having Diabetes, Limit Free text SBC Scenario, Having Diabetes, Limit This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans SBCHavingSimplefractureDeductible 22

23 Data The Center for Consumer Information & Insurance Oversight The dollar amount of the deductible for the sample SBC scenario of treatment of a simple fracture SBC Scenario, Treatment of a Simple Fracture, Deductible Free text SBC Scenario, Treatment of a Simple Fracture, Deductible This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans Data SBCHavingSimplefractureCopayment The dollar amount of the copayment for the sample SBC scenario of treatment of a simple fracture SBC Scenario, Treatment of a Simple Fracture, Copayment Free text SBC Scenario, Treatment of a Simple Fracture, Copayment This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans SBCHavingSimplefractureCoinsurance The dollar amount of the coinsurance for the sample SBC scenario of treatment of a simple fracture SBC Scenario, Treatment of a Simple Fracture, Coinsurance Free text Data SBC Scenario, Treatment of a Simple Fracture, Coinsurance This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans Data SBCHavingSimplefractureLimit The dollar amount of the benefit limits or exclusions for the sample SBC scenario of treatment of a simple fracture SBC Scenario, Treatment of a Simple Fracture, Limit Free text SBC Scenario, Treatment of a Simple Fracture, Limit 23

24 Data This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans SpecialtyDrugMaximumCoinsurance The maximum dollar value of coinsurance for specialty high-cost drugs Specialty Drug Maximum Coinsurance Free text 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 Inpatient Copayment Maximum Days Allowable Values: 0 (equivale nt to no maximum) Data Field Maximum Number of Days for Charging an Inpatient Copay? Name from Data Comments This field is optional, so blanks or zero values indicate a value was not provided : Name: Definition: BeginPrimaryCareCostSharingAfterNumberOfVisits The maximum number of fully covered visits allowed, after which primary care cost sharing will begin 24

25 Begin Primary Care Cost-Sharing After Number Of Visits Label: Allowable 0 (equivale Values: nt to no maximum) Data Field Begin Primary Care Cost-Sharing After a Set Number of Visits? Name from Data Comments 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 Begin Primary Care Deductible Coinsurance After Number Of Copays Allowable Values: 0 (equiva lent to no maximum) Data Field Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays? Name from 25

26 Data This field is optional, blanks or zero values indicate a value was not provided Name: Definition: Data Type: Label: Allowable Values: Data Field Name from Data Comments : MEHBInnTier1IndividualMOOP The dollar amount of the tier 1 in network, individual out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $X 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 Name: Definition: Data Type: Label: Allowable Values: Data Field Name from Data Comments : MEHBInnTier1FamilyPerPersonMOOP The dollar amount of the tier 1 in network, family per person out-ofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $X Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person 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 26

27 MEHBInnTier1FamilyPerGroupMOOP The dollar amount of the tier 1 in network, family per group outofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Individual 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 MEHBInnTier2FamilyPerPersonMOOP The dollar amount of the tier 2 in network, family per person outofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person 27

28 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; this field contains the MOOP value for dental benefits MEHBInnTier2FamilyPerGroupMOOP The dollar amount of the tier 2 in network, family per group outofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with multiple in network tiers and separate medical and drug MOOP limits; 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 Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual 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 MEHBOutOfNetFamilyPerPersonMOOP The dollar amount of the out of network, family per person outofpocket cost limit for medical EHB benefits 28

29 Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person This field is not available for the 2014 or 2015 datasets. 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 MEHBOutOfNetFamilyPerGroupMOOP The dollar amount of the out of network, family per group outofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 outof-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Individual Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Individual 29

30 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 MEHBCombInnOonFamilyPerPersonMOOP The dollar amount of the combined in/out of network, family per person out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person This field is not available for the 2014 or 2015 datasets. 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 30

31 MEHBCombInnOonFamilyPerGroupMOOP The dollar amount of the combined in/out of network, family per group out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group Data Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual Data 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 DEHBInnTier1FamilyPerPersonMOOP The dollar amount of the tier 1 in network, family per person outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Person Data Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans 31

32 DEHBInnTier1FamilyPerGroupMOOP The dollar amount of the tier 1 in network, family per group outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Group Data Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual Data 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 DEHBInnTier2FamilyPerPersonMOOP The dollar amount of the tier 2 in network, family per person outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Person Data Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Person 32

33 This field is not available for the 2014 or 2015 datasets. 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 DEHBInnTier2FamilyPerGroupMOOP The dollar amount of the tier 2 in network, family per group outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Group Data Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual Data 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 DEHBOutOfNetFamilyPerPersonMOOP The dollar amount of the out of network, family per person outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Person 33

34 Data Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans DEHBOutOfNetFamilyPerGroupMOOP The dollar amount of the out of network, family per group outofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Group Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 outof-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual 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 DEHBCombInnOonFamilyPerPersonMOOP The dollar amount of the combined in/out of network, family per person out-of-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Per Person 34

35 Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug MOOP limits; this field will be blank for dental plans DEHBCombInnOonFamilyPerGroupMOOP The dollar amount of the combined in/out of network, family per group out-of-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Per Group Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual 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 TEHBInnTier1FamilyPerPersonMOOP The dollar amount of the tier 1 in network, family per person outofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person 35

36 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans TEHBInnTier1FamilyPerGroupMOOP The dollar amount of the tier 1 in network, family per group outofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group Data Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual Data 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 TEHBInnTier2FamilyPerPersonMOOP The dollar amount of the tier 2 in network, family per person outofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person 36

37 Data Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person This field is not available for the 2014 or 2015 datasets. 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 TEHBInnTier2FamilyPerGroupMOOP The dollar amount of the tier 2 in network, family per group outofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group Data Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual 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 TEHBOutOfNetFamilyPerPersonMOOP The dollar amount of the out of network, family per person outofpocket cost limit for medical and drug EHB benefits 37

38 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans TEHBOutOfNetFamilyPerGroupMOOP The dollar amount of the out of network, family per group outofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 outof-pocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $X 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 TEHBCombInnOonFamilyPerPersonMOOP The dollar amount of the combined in/out of network, family per person out-of-pocket cost limit for medical and drug EHB benefits 38

39 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans TEHBCombInnOonFamilyPerGroupMOOP The dollar amount of the combined in/out of network, family per group out-of-pocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Medical EHB Deductible, In Network (Tier 1), Individual 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 MEHBDedInnTier1FamilyPerPerson The dollar amount of the tier 1 in network, family per person deductible for medical EHB benefits 39

40 Medical EHB Deductible, In Network (Tier 1), Family Per Person Medical EHB Deductible, In Network (Tier 1), Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedInnTier1FamilyPerGroup The dollar amount of the tier 1 in network, family per group deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 1), Family Per Group Medical EHB Deductible, In Network (Tier 1), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Medical EHB Deductible, In Network (Tier 1), Default Coinsurance Free text 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 Medical EHB Deductible, In Network (Tier 2), Individual 40

41 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 MEHBDedInnTier2FamilyPerPerson The dollar amount of the tier 2 in network, family per person deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 2), Family Per Person Medical EHB Deductible, In Network (Tier 2), Family Per Person This field is not available for the 2014 or 2015 datasets. 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 MEHBDedInnTier2FamilyPerGroup The dollar amount of the tier 2 in network, family per group deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 2), Family Per Group Medical EHB Deductible, In Network (Tier 2), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Medical EHB Deductible, In Network (Tier 2), Default Coinsurance 41

42 Free text Data 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 Medical EHB Deductible, Out of Network, Individual Data 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 MEHBDedOutOfNetFamilyPerPerson The dollar amount of the out of network, family per person deductible for medical EHB benefits Medical EHB Deductible, Out of Network, Family Per Person Data Medical EHB Deductible, Out of Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedOutOfNetFamilyPerGroup The dollar amount of the out of network, family per group deductible for medical EHB benefits Medical EHB Deductible, Out of Network, Family Per Group 42

43 Medical EHB Deductible, Out of Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Medical EHB Deductible, Combined In/Out of Network, Individual 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 MEHBDedCombInnOonFamilyPerPerson The dollar amount of the combined in/out of network, family per person deductible for medical EHB benefits Medical EHB Deductible, Combined In/Out of Network, Family Per Person Medical EHB Deductible, Combined In/Out of Network, Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedCombInnOonFamilyPerGroup The dollar amount of the combined in/out of network, family per group deductible for medical EHB benefits Medical EHB Deductible, Combined In/Out of Network, Family Per Group 43

44 Medical EHB Deductible, Combined In/Out of Network, Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Drug EHB Deductible, In Network (Tier 1), Individual 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 DEHBDedInnTier1FamilyPerPerson The dollar amount of the tier 1 in network, family per person deductible for drug EHB benefits Drug EHB Deductible, In Network (Tier 1), Family Per Person Drug EHB Deductible, In Network (Tier 1), Family Per Person This field is not available for the 2014 or 2015 datasets. This field is only applicable for plans with separate medical and drug deductibles; for dental plans, this field contains the deductible for dental benefits DEHBDedInnTier1FamilyPerGroup The dollar amount of the tier 1 in network, family per group deductible for drug EHB benefits Drug EHB Deductible, In Network (Tier 1), Family Per Group 44

45 Drug EHB Deductible, In Network (Tier 1), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Drug EHB Deductible, In Network (Tier 1), Default Coinsurance Free text 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 Drug EHB Deductible, In Network (Tier 2), Individual 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 DEHBDedInnTier2FamilyPerPerson The dollar amount of the tier 2 in network, family per person deductible for drug EHB benefits Drug EHB Deductible, In Network (Tier 2), Family Per Person 45

46 Drug EHB Deductible, In Network (Tier 2), Family Per Person This field is not available for the 2014 or 2015 datasets. 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 DEHBDedInnTier2FamilyPerGroup The dollar amount of the tier 2 in network, family per group deductible for drug EHB benefits Drug EHB Deductible, In Network (Tier 2), Family Per Group Data Drug EHB Deductible, In Network (Tier 2), Family Per Group This field is not available for the 2014 or 2015 datasets. 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 Drug EHB Deductible, In Network (Tier 2), Default Coinsurance Free text Data 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 Drug EHB Deductible, Out of Network, Individual Data Drug EHB Deductible, Out of Network, Individual 46