The Center for Consumer Information & Insurance Oversight Plan Attributes Public Use File Data Dictionary
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- Georgina Harper
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1 CMS Center for Consumer Information & Insurance Oversight (CCIIO), Health Insurance Exchange Public Use Files (Exchange 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) publishes the Exchange PUFs in order to improve transparency and increase access to data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered through the Exchange in the individual market and Small Business Health Options Program (SHOP). The PUFs include data from states with Federally-facilitated Exchanges (FFEs), which include states with State Partnership Exchanges (SPEs) and State-based Exchanges that rely on the federal information technology platform for QHP eligibility and enrollment functionality (SBE-FPs). The Exchange PUFs also include data on Multi- State Plans (MSPs) and certified off-exchange SADPs. The PUFs do not include data from SBEs 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 Exchange PUFs. The Plan-PUF contains plan variant-level data on maximum out of pocket payments, deductibles, 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 reports plan characteristics at the plan-variant level. The Plan-PUF is available for plan years 2014 through Variable Attributes BusinessYear Year for which plan provides coverage to enrollees Business Year System-generated field Business Year N/A 1
2 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 State Code N/A IssuerId Five-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS) Issuer ID System-generated field Issuer ID N/A SourceName Categorical identifier of source of data import Source Name HIOS SERFF OPM System-generated field Source Name N/A VersionNum Integer value for version of data import Version Number System-generated field Version Number This field is only available for the 2014, 2015, and 2016 datasets. ImportDate Date of data import 2
3 Date/Time Import Date System-generated field Import Date N/A BenefitPackageId Numeric identifier of benefit package System-generated field Benefit Package ID This field is only available for the 2014, 2015, and 2016 datasets. IssuerId2 Five-digit numeric code that identifies the issuer organization in HIOS Issuer ID HIOS Issuer ID This field is only available for the 2014, 2015, and 2016 datasets. StateCode2 Two-character state abbreviation indicating the state where the plan is offered State Code All 50 state abbreviations + 9 territory abbreviations Issuer State This field is only available for the 2014, 2015, and 2016 datasets. MarketCoverage Categorical indicator of market coverage of plan Market Coverage Individual SHOP (Small Group) 3
4 Market Coverage N/A DentalOnlyPlan Categorical indicator of dental-only status of plan Dental-Only Plan Indicator Yes No Dental Only Plan N/A TIN Tax ID Number of issuer Tax Identification Number TIN N/A StandardComponentId Fourteen-character alpha-numeric code that identifies an insurance plan within HIOS Plan ID HIOS Plan ID (Standard Component) N/A PlanMarketingName Marketing name of insurance plan Plan Marketing Name Plan Marketing Name N/A 4
5 HIOSProductId Seven- character alpha-numeric code that identifies an insurance product within HIOS HIOS Product ID HIOS Product ID N/A HPID Identifies the insurance product using a National Health Plan Identifier HPID (National Health Plan Identifier) 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 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 5
6 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 Exchange 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 MetalLevel Metal level, or coverage category, of insurance plan based on its actuarial value Metal Level Platinum Gold Silver 6
7 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 only available for the 2017 and 2018 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 status (On the Exchange, Off the Exchange) QHP/Non QHP On Exchange Off Exchange Both 7
8 QHP/Non QHP N/A IsNoticeRequiredForPregnancy An indication of whether notice to the issuer is required before pregnancy-related benefits will be covered Notice Required for Pregnancy Yes No Notice Required for Pregnancy This field is not applicable for dental plans IsReferralRequiredForSpecialist An indication of whether pre-authorization is required before a specialist visit Is a Referral Required for Specialist? Yes No Is a Referral Required for Specialist? This field is not applicable for dental plans SpecialistRequiringReferral The types of specialists that require pre-authorization Specialist Requiring a Referral Specialist Requiring a Referral 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 Plan Level Exclusions 8
9 This field is optional; blanks indicate a value was not provided 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 Limited Cost Sharing Plan Variation - Est Advanced Payment This field is not applicable for dental plans; this field should be blank for medical plans CompositeRatingOffered An indication of whether issuers and employers can use the composite premium field. Composite Rating Offered Yes No Does this plan offer Composite Rating? This field will equal No for individual market plans 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 Child-Only Offering This field is not applicable for catastrophic plans ChildOnlyPlanId The HIOS Plan Identifier for the child-only insurance plan that corresponds to this insurance plan Child Only Plan ID 9
10 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 (This value is only available in the 2016, 2017, and 2018 datasets.) Disease Management Programs Offered 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 10
11 This field is only valid for medical plans and is not required for catastrophic plans. EHBPercentPremiumS4 The projected percent of the plan s total premium relative to the EHB benchmark plan for the state. EHB Percent of Total Premium, Section 4 0-1, blank EHB Percent of TP, Section IV This field is only available for the 2014 & 2015 dataset. This field is only valid for medical plans. EHBPediatricDentalApportionmentQuantity The dollar amount or percentage of the EHB Apportionment for Pediatric Dental EHB Apportionment for Pediatric Dental 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 and 2018 dataset. 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 This field is not applicable for medical plans PlanEffectiveDate The activation date of enrollment coverage on an Insurance plan Date Plan Effective Date 11
12 Plan Effective Date N/A PlanExpirationDate The end date of plan selection for enrollment on an Insurance plan Date Plan Expiration Date 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 Out of Country Coverage Description Out of Country Coverage Description This field is only applicable for plans that offer out of country coverage OutOfServiceAreaCoverage Indicates whether out of service area coverage is provided Out of Service Area Coverage Yes No 12
13 Out of Service Area Coverage N/A OutOfServiceAreaCoverageDescription The conditions under which out of service area health services are covered Out of Service Area Coverage Description Out of Service Area Coverage Description 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 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 Formulary URL 13
14 This field is only available for the 2015, 2016, 2017, and 2018 datasets. This field is only valid for medical plans 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) HIOS Plan ID (Standard Component + Variant) Prepopulated in template; character count includes - PlanVariantMarketingName Marketing name of the plan variation of the insurance plan Plan Variant Marketing Name Plan Variant Marketing Name This field is only available for the 2017 and 2018 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 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 14
15 Issuer Actuarial Value This field is only applicable for dental plans and plans with a unique plan design AVCalculatorOutputNumber The numeric AV generated by the template s AV Calculator for an insurance plan AV Calculator Output Number AV Calculator Output Number This field is only applicable for medical plans and plans that do not have a unique plan design 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 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 An indication of whether there are two in network tiers Multiple In Network Tiers 15
16 Yes No Multiple In Network Tiers? N/A FirstTierUtilization The expected percentage of utilization for the first in network tier First Tier Utilization 1st Tier Utilization N/A SecondTierUtilization 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 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 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 SBCHavingaBabyCopayment The dollar amount of the copayment for the sample SBC scenario of having a baby SBC Scenario, Having a Baby, Copayment 16
17 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 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 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 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 17
18 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 SBC Scenario, Having Diabetes, Coinsurance This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans SBCHavingDiabetesLimit The dollar amount of the benefit limits or exclusions for the sample SBC scenario of having diabetes SBC Scenario, Having Diabetes, Limit 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 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 SBC Scenario, Treatment of a Simple Fracture, Deductible This field is only available for the 2017 and 2018 datasets. This field is not applicable This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans SBCHavingSimplefractureCopayment The dollar amount of the copayment for the sample SBC scenario of treatment of a simple fracture 18
19 SBC Scenario, Treatment of a Simple Fracture, Copayment SBC Scenario, Treatment of a Simple Fracture, Copayment This field is only available for the 2017 and 2018 datasets. 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 SBC Scenario, Treatment of a Simple Fracture, Coinsurance This field is only available for the 2017 and 2018 datasets. This field is optional; blanks indicate a value was not provided; this field is not applicable for dental plans 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 SBC Scenario, Treatment of a Simple Fracture, Limit This field is only available for the 2017 and 2018 datasets. 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 Maximum Coinsurance for Specialty Drugs This field is optional; blanks indicate a value was not provided 19
20 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 0 (equivalent to no maximum) Maximum Number of Days for Charging an Inpatient Copay? This field is optional, so blanks or zero values indicate a value was not provided BeginPrimaryCareCostSharingAfterNumberOfVisits The maximum number of fully covered visits allowed, after which primary care cost sharing will begin Begin Primary Care Cost-Sharing After Number Of Visits 0 (equivalent to no maximum) Begin Primary Care Cost-Sharing After a Set Number of Visits? This field is optional, so blanks or zero values indicate a value was not provided BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays 20
21 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 0 (equivalent to no maximum) Begin Primary Care Deductible/ Coinsurance After a Set Number of Copays? This field is optional, blanks or zero values indicate a value was not provided 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 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual MOOP limits; for dental plans, this field contains the MOOP value for dental benefits MEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family 21
22 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family This field only applies to the 2014 and 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 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 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person MOOP limits; for dental plans, this field contains the MOOP value for dental benefits MEHBInnTier1FamilyPerGroupMOOP The dollar amount of the tier 1 in network, family per group out-ofpocket 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 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 22
23 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 MEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family This field is only available for the 2014 and 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 MEHBInnTier2FamilyPerPersonMOOP The dollar amount of the tier 2 in network, family per person out-ofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person 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 out-ofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group 23
24 Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group 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 MOOP limits; for dental plans, this field contains the MOOP value for dental benefits MEHBOutOfNetFamilyMOOP The dollar amount of the out of network, family out-of-pocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family This field is only available for the 2014 and 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 MEHBOutOfNetFamilyPerPersonMOOP The dollar amount of the out of network, family per person out-ofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person 24
25 Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person 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 out-ofpocket 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 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 MOOP limits; for dental plans, this field contains the MOOP value for dental benefits MEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-ofpocket cost limit for medical EHB benefits Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family 25
26 Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family This field is only available for the 2014 and 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 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 MOOP limits; for dental plans, this field contains the MOOP value for dental benefits 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 Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group 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 26
27 Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual MOOP limits; this field will be blank for dental plans DEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family out-of-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family This field is only available for the 2014 and 2015 datasets. 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 out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Person Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Person MOOP limits; this field will be blank for dental plans DEHBInnTier1FamilyPerGroupMOOP The dollar amount of the tier 1 in network, family per group out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Group 27
28 Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Family Per Group 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 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 DEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family out-of-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family This field is only available for the 2014 and 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 DEHBInnTier2FamilyPerPersonMOOP The dollar amount of the tier 2 in network, family per person out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Person 28
29 Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Person 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 out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Group Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Family Per Group 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 Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual MOOP limits; this field will be blank for dental plans DEHBOutOfNetFamilyMOOP The dollar amount of the out of network, family out-of-pocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family 29
30 Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family This field is only available for the 2014 and 2015 datasets. 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 out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Person Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family Per Person MOOP limits; this field will be blank for dental plans DEHBOutOfNetFamilyPerGroupMOOP The dollar amount of the out of network, family per group out-ofpocket 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 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 30
31 MOOP limits; this field will be blank for dental plans DEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-ofpocket cost limit for drug EHB benefits Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family This field is only available for the 2014 and 2015 datasets. 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 Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family Per Person 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 MOOP limits; this field will be blank for dental plans 31
32 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 TEHBInnTier1FamilyMOOP The dollar amount of the tier 1 in network, family 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), Family Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family This field is only available for the 2014 and 2015 datasets. 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 out-ofpocket 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person This field is only applicable for plans with combined medical and drug MOOP limits; this field will be blank for dental plans TEHBInnTier1FamilyPerGroupMOOP 32
33 The dollar amount of the tier 1 in network, family per group out-ofpocket 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group 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 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 TEHBInnTier2FamilyMOOP The dollar amount of the tier 2 in network, family 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), Family Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family This field is only available for the 2014 and 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 TEHBInnTier2FamilyPerPersonMOOP 33
34 The dollar amount of the tier 2 in network, family per person out-ofpocket 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person 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 out-ofpocket 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 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group 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 TEHBOutOfNetFamilyMOOP 34
35 The dollar amount of the out of network, family 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, Family Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family This field is only available for the 2014 and 2015 datasets. 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 out-ofpocket cost limit for medical and drug EHB benefits 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 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 out-ofpocket 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 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 35
36 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual 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 TEHBCombInnOonFamilyMOOP The dollar amount of the combined in/out of network, family out-ofpocket cost limit for medical and drug EHB benefits Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family This field is only available for the 2014 and 2015 datasets. 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 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 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 36
37 Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group 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 deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedInnTier1Family The dollar amount of the tier 1 in network, family deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 1), Family Medical EHB Deductible, In Network (Tier 1), Family This field is only available for the 2014 and 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 MEHBDedInnTier1FamilyPerPerson The dollar amount of the tier 1 in network, family per person deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 1), Family Per Person 37
38 Medical EHB Deductible, In Network (Tier 1), Family Per Person 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 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 Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 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 Medical EHB Deductible, In Network (Tier 2), Individual 38
39 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 MEHBDedInnTier2Family The dollar amount of the tier 2 in network, family deductible for medical EHB benefits Medical EHB Deductible, In Network (Tier 2), Family Medical EHB Deductible, In Network (Tier 2), Family This field is only available for the 2014 and 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 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 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 only applicable for plans with multiple in network tiers and 39
40 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 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 Medical EHB Deductible, Out of Network, Individual deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedOutOfNetFamily The dollar amount of the out of network, family deductible for medical EHB benefits Medical EHB Deductible, Out of Network, Family Medical EHB Deductible, Out of Network, Family This field is only available for the 2014 and 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 MEHBDedOutOfNetFamilyPerPerson 40
41 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 Medical EHB Deductible, Out of Network, Family Per Person 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 Medical EHB Deductible, Out of Network, Family Per Group 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 deductibles; for dental plans, this field contains the deductible for dental benefits MEHBDedCombInnOonFamily The dollar amount of the combined in/out of network, family deductible for medical EHB benefits 41
42 Medical EHB Deductible, Combined In/Out of Network, Family Medical EHB Deductible, Combined In/Out of Network, Family This field is only available for the 2014 and 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 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 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 Medical EHB Deductible, Combined In/Out of Network, Family Per Group deductibles; for dental plans, this field contains the deductible for dental benefits DEHBDedInnTier1Individual 42
43 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 deductibles; for dental plans, this field contains the deductible for dental benefits DEHBDedInnTier1Family The dollar amount of the tier 1 in network, family deductible for drug EHB benefits Drug EHB Deductible, In Network (Tier 1), Family Drug EHB Deductible, In Network (Tier 1), Family This field is only available for the 2014 and 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 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 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 43
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