Health Insurance Plans Unified Rate Review PUF 2015

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health-insurance-plans-unified-rate-review-puf-2015-csv  

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Field information

Field Name Order Type (Format) Description
Company_Legal_Name 1 string Organization’s legal entity name. Name that is associated with the HIOS Issuer ID
HIOS_Issuer_ID 2 number Health Insurance Oversight system Issuer ID assigned to the legal entity.
Effective_Date_Of_Rate_Change 3 date (%Y-%m-%d) The effective date for which rates are being submitted.
Template_ID 4 number Template ID generated by the system
State 5 string Code for the State
Market 6 string The applicable market: Individual, Small Group, or Combined. The market chosen must be consistent with the state’s determination of their allowable markets (e.g. if a state chooses to merge the individual and small group market, the issuer must choose “Combined”).
Product 7 string Insurance product. The term “product” is defined as a unique combination of benefits, various cost sharing options and a network design(s) to a particular service area. “Product” has the same meaning as included in 45 CFR Part 154
Product_ID 8 string Insurance product ID, the product ID that corresponds with each product. The two-letter state code portion of the Product ID must be entered using capital letters. The “Product ID” should be the product number assigned by HIOS. Each product included in the single risk pool during the Experience Period, as well as new products that are part of the rate filing, must be identified in Worksheet 2 of the template
Metal 9 string Insurance Metal: For each “plan” within a product, there is a corresponding metal level, Platinum, Gold, Silver, Bronze and Catastrophic. Plans that are included in a QHP certification application must show the same Metal as is shown in the QHP application
AV_Metal_Value 10 string The term “actuarial value” is used to describe a manner of estimating the value of a plan, but not a specific manner. AV Metal Value refers to the federal definition of actuarial value as prescribed in 45 CFR Part 156, §156.20. AV requirements for Platinum hold 90%, Gold hold 80%, Silver 70%, Bronze 60% and Catastrophic: Not specified by law
AV_Pricing_Value 11 string The AV Pricing Value represents the cumulative effect of adjustments made by the issuer to move from the Market Adjusted Index Rate to the Plan Adjusted Index Rate. It is likely to have a spread from one plan to another that emulates the spread in the Plan Adjusted Index Rates of the same plans.
Plan_Type 12 string Plan Types are Indemnity, PPO, POS, HMO or EPO. The term “plan” is defined as a unique combination of benefits to a specific set of cost sharing options and network design(s) to a particular service area.
Plan_Name 13 string The name of each plan within a product. The term “plan” is defined as a unique combination of benefits to a specific set of cost sharing options and network design(s) to a particular service area. Most products will be made up of multiple plans that produce an actuarial value equal to one of the metal levels permitted under the ACA. The Plan Name is the marketing name used when referring to the specific set of benefits and cost sharing values. The Plan Name shown should be consistent across submissions (e.g., QHP application, state filings).
Plan_ID_Standard_Component_ID 14 string Assigned Plan ID. The two-letter state code portion of the Plan ID must be entered using capital letters. The Plan ID is a unique identifier for the set of benefits and cost sharing values offered within a product by the HIOS issuer, or in other words, a unique identifier of each plan. Plan IDs contain three digits. This field must be entered as a text input and must include any leading zeros (e.g. 001).
Exchange_Plan 15 number Exchange plan, is an indicator as to whether the plan will be offered inside a State-based or Federally Facilitated Exchange or Small Business Health Options Program (SHOP), regardless of whether or not it will also be offered in the outside market. If an application for qualified health plan status is pending, it is indicated “yes.” This indicator should not be used to identify whether a plan is offered on a private exchange.
Historical_Rate_Increase_Calendar_Year_2 16 number For each product, the historical rate increase for the period two years prior to the current calendar year.
Historical_Rate_Increase_Calendar_Year_1 17 number For each product, the historical rate increase for the period of one year prior to the current calendar year.
Historical_Rate_Increase_Calendar_Year_0 18 number For each product, the historical rate increase for the current calendar year.
Effective_Date_Of_Proposed_Rate 19 date (%Y-%m-%d) The corresponding effective date of the proposed rate increases.
Rate_Change_In_Percent_Over_Prior_Filing 20 string Average change in premium rates over the rates included in the prior filing for each plan. All products and plans must have the same effective date. If some products or plans will have a rate change and others will not, then a 0% rate change may be entered in the “Rate Change % (over prior filing)” field described immediately below for those plans that will not have a rate change on the product’s effective date. For new plans enter 0.00% in this field.
Cumulative_Rate_Change_In_Percent_Over_12_Months_Prior 21 number The average change in premium rates over the twelve month period prior to the effective date for each plan. This should be the premium weighted average of the 12-month increases that apply at renewal. For new plans enter -999.00% in this field. It is important to enter this value in the template in this case so other calculated fields in the template are correctly generated.
Projected_Per_Rate_Change_In_Percent_Over_Experience_Period 22 number For each plan, the percentage change in rates between the Experience Period and the Projection Period is shown. This is a calculated field.
Product_Threshold_Rate_Increase_In_Percent 23 number The template calculates the threshold rate increase for each product. This is the rate increase that determines whether the rate increase is subject to review, per 45 CFR Part 154 §154.200.
Plan_Rate_Increase_By_Inpatient 24 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product.
Plan_Rate_Increase_By_Outpatient 25 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Professional 26 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Prescription_Drug 27 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Other 28 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Capitation 29 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Administration 30 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Taxes_And_Fees 31 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Rate_Increase_By_Risk_And_Profit_Change 32 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Total_Rate_Increase 33 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Member_Cost_Share_Increase 34 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Average_Current_Rate_PMPM 35 number Is a Component of Premium Increase (PMPM Dollar Amount above Current Average Rate PMPM. This can be completed with variations only at the product level or variations at each plan level within a product. If the information is entered with the product level variation, this means the issuer enters the information for the total product spread evenly across all plans within the product. If the issuer chooses this methodology, the proposed rate increase for each plan within the product must be identical.
Plan_Projected_Member_Months 36 number The projected member months by plan that correspond to the effective period of the rates for each plan.
Base_Period_Average_Rate_PMPM 37 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The average premium rate PMPM for each plan during the experience period. The average should be generated using membership consistent with the Experience Period for each plan.
Base_Period_Member_Months 38 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The total member months during the Experience Period should be consistent with the Experience Period Member Months.
Base_Period_Total_Premium 39 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The total premium earned in the Experience Period for each plan is calculated as the Average Rate PMPM multiplied by the Member Months in a given plan.
Base_Period_EHB_Basis_Or_Full_Portion_Of_TP 40 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total premium that is associated with EHB services in each plan (including administrative expenses and profit associated with those services). When calculating the EHB Percent of TP, the Administrative Expense Load, Profit & Risk Load, and Taxes & Fees should be allocated to the various categories in this section (EHB, state mandated benefits that are not EHB, and other benefits) of the template in proportion to the claims expenses.
Base_Period_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHB 41 string The information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total premium for each plan that is associated with state mandated benefits that are not part of the EHB package.
Base_Period_Other_Benefits_Portion_Of_TP 42 string The information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above.
Base_Period_Total_Allowed_Claims 43 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The total allowed claims for each benefit plan with service dates within the Experience Period. The Total Allowed Claims (TAC) across all benefit plans for the Experience Period should be consistent with the Allowed Claims
Base_Period_EHB_Basis_Or_Full_Portion_Of_TAC 44 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total allowed claims that are associated with EHB services in each plan during the Experience Period.
Base_Period_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHB 45 string The information shown in this section captures the historical data for the twelve month period used in the base period experience. The percentage of the total allowed claims for each plan that are associated with state mandated benefits that are not part of the EHB package.
Base_Period_Other_Benefits_Portion_of_TAC 46 string The information shown in this section captures the historical data for the twelve month period used in the base period experience.This is a calculated field which generates the remaining percentage of the total allowed claims based on the values entered from the EHB and state mandated benefits portions. As stated previously, the sum of the EHB portion, the state mandated benefit portion not associated with EHBs and the other benefits portion should equal 100%.
Base_Period_Allowed_Claims_Which_Are_Not_The_Issuers_Obligation 47 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The portion of the allowed claims that were paid by the insured or other funds for each plan separately during the experience period. These would include the following types of payments: Member cost sharing (i.e. deductible, coinsurance and copays). Risk transfer charges or payments associated with the risk adjustment program, Federal reinsurance payments received, other claims that are not described above.
Base_Period_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_Person 48 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The portion of the total dollars that are attributable to HHS during the Experience Period. This is the cost sharing reduction subsidies.
Base_Period_Portion_Payable_By_HHS_On_Behalf_Of_Insured_Person_Percent 49 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.
Base_Period_Total_Incurred_Claims_Payable_With_Issuer_Funds 50 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. This is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.
Base_Period_Net_Amount_Of_Reinsurance 51 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The Federal reinsurance amount received for each plan during the Experience Period.
Base_Period_Net_Amount_Of_Risk_Adjusted 52 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The risk transfer charge or payment during the Experience Period for each plan
Base_Period_Incurred_Claims_PMPM 53 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Base_Period_Allowed_Claims_PMPM 54 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Base_Period_EHB_Portion_Of_Allowed_Claims_PMPM 55 number The information shown in this section captures the historical data for the twelve month period used in the base period experience. The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Projected_Plan_Adjusted_Index_Rate 56 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Member_Months 57 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state). The template populates the projected Member Months using the Projected Member Months.
Projected_Total_Premium 58 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_EHB_Basis_Or_Full_Portion_Of_TP 59 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHB 60 string
Projected_Other_Benefits_Portion_Of_TP 61 string The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Total_Allowed_Claims 62 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_EHB_Basis_Or_Full_Portion_Of_TAC 63 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHB 64 string
Projected_Other_Benefits_Portion_Of_TAC 65 string The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Allowed_Claims_Which_Are_Not_The_Issuers_Obligation 66 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_Person 67 number
Projected_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_Person 68 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Total_Incurred_Claims_Payable_with_Issuer_Funds 69 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state). The portion of the total dollars attributable to HHS during the projection period. This is the cost sharing reduction subsidies.
Projected_Net_Amount_Of_Reinsurance 70 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Net_Amount_Of_Risk_Adjusted 71 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Incurred_Claims_PMPM 72 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Projected_Allowed_Claims_PMPM 73 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Plan_Section_4_Plan_Member_Months 74 number The number of member months expected to be covered
Projected_EHB_Portion_Of_Allowed_Claims_PMPM 75 number The projected data is for the twelve month period following the effective date for each plan. The information is entered at the product level or at the plan level. These circumstances occur in the small group market when prospective trend is included in the submission (if permitted by the state).
Plan_Section_4_Plan_Adjusted_Index_Rate 76 number The Plan Adjusted Index Rate is the Market Adjusted Index Rate further adjusted for plan specific factors allowed by 45 CFR Part 156.80(d)(2) such as provider network, utilization management, benefits in addition to Essential Health Benefits (EHBs), actuarial value and cost sharing, distribution and administrative costs (less Exchange fees) and catastrophic plan eligibility variation.
Plan_Section_4_Total_Premium 77 number The total premium earned in the projection period for each plan is calculated as the Average Rate PMPM multiplied by the Member Months in a given plan.
Plan_Section_4_EHB_Basis_Or_Full_Portion_Of_TP 78 string The percentage of the total premium that is associated with EHB services in each plan (including administrative expenses and profit associated with those services). When calculating the EHB Percent of TP, the Administrative Expense Load, Profit & Risk Load, and Taxes & Fees should be allocated to the various categories in this section (EHB, state mandated benefits that are not EHB, and other benefits) of the template in proportion to the claims expenses.
Plan_Section_4_State_Mandated_Benefits_Portion_Of_TP_Other_Than_EHB 79 number The percentage of the total premium for each plan that is associated with state mandated benefits that are not part of the EHB package.
Plan_Section_4_Net_Amount_Of_Risk_Adjusted 80 number The amount of any risk transfer payment expected to be received during the projection period for each plan. If a risk transfer charge is anticipated to be assessed, the value entered should be negative.
Plan_Section_4_Other_Benefits_Portion_Of_TP 81 number This is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above. As stated previously, the sum of the EHB portion, the state mandated benefit portion not associated with EHBs and the other benefits portion should equal 100%.
Plan_Section_4_Total_Allowed_Claims 82 number The total allowed claims for each benefit plan with service dates within the projection period
Plan_Section_4_Net_Amount_Of_Reinsurance 83 number The Federal reinsurance amount expected to be received for each plan during the projection period, net of the reinsurance assessments
Plan_Section_4_EHB_Basis_Or_Full_Portion_Of_TAC 84 number
Plan_Section_4_State_Mandated_Benefits_Portion_Of_TAC_Other_Than_EHB 85 string
Plan_Section_4_Total_Incurred_Claims_Payable_With_Issuer_Funds 86 number Total claims incurred payable with issuer funds
Plan_Section_4_Other_Benefits_Portion_Of_TAC 87 number This is a calculated field which generates the remaining percentage of the total premium based on the values entered from the EHB and state mandated benefits portions, described above.
Plan_Section_4_Allowed_Claims_Which_Are_Not_The_Issuers_Obligation 88 number Allowed claim which are not the issuers obligation
Plan_Sec_4_Portion_Payable_By_HHS_Funds_On_Behalf_Of_Insured_Person 89 number The portion of the total dollars that are attributable to HHS during the Experience Period. This is the cost sharing reduction subsidies.
Plan_Sec_4_Percent_Portion_Payable_By_HHS_On_Behalf_Of_Insured_Person 90 number This is a calculated field and displays the percentage of claims covered by HHS over the value of all claims not covered by the issuer.
Plan_Section_4_Incurred_Claims_PMPM 91 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Plan_Section_4_Plan_Allowed_Claims_PMPM 92 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Plan_EHB_Portion_Of_Allowed_Claims_PMPM 93 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Premiums_Net_Of_MLR_Rebate_In_Experience_Period_PMPM 94 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Experience_Period_Member_Months 95 number The total number of months of coverage in the experience period for all members that had coverage during any portion of the Experience Period.
Premiums_Net_Of_MLR_Rebate_In_Experience_Period_Claims_Amount 96 number The amount of premium earned during the Experience Period, net of rebates to policyholders on an incurred basis due to the medical loss ratio (MLR) requirements as defined in 45 CFR § 158.
Allowed_Claims_Amount 97 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Incurred_Claims_Amount_In_Experience_Period 98 number Total claims incurred in the Experience Period.
Incurred_Claims_In_Experience_Period_PMPM 99 number PMPM incurred claims amount in the experience period
Allowed_Claims_PMPM 100 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Single_Risk_Pool_Gross_Premium_Average_Rate_PMPM 101 number The issuer is required to provide support that the single risk pool in a particular state and market is established according to the requirements in 45 CFR § 156.80(d). The single risk pool reflects all covered lives for every non-grandfathered product/plan combination for an issuer in a state and market. The single risk pool is specific to the legal entity for the state and market for which it is submitted. The template calculates this value by dividing the Projected Incurred Claims by 1 minus the Administrative Expense Load percentage less the Profit & Risk Load percentage less Taxes & Fees percentage.
Projected_Member_Month_Projected_Experience 102 number The number of member months expected to be covered during the Projection Period.
Single_Risk_Pool_Gross_Premium_Avg_Rate_PMPM_Projected_Period_Totals 103 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Projected_Incurred_Claims_Projected_Period_Totals 104 number The template calculates aggregate dollar amounts for Section III PMPM values entered into or calculated by the template. The amounts are calculated by multiplying the Projected Member Months by the applicable PMPM value.
Projected_ACA_Reinsurance_Recoveries_Net_Of_Reinsurance_Premium_PMPM 105 number Projected reinsurance recoveries, referred to as reinsurance payments in the HHS Notice of Benefit and Payment Parameters, from the Federal reinsurance program, less contributions made to the program (referred to as “Premium” in the template).
Projected_Incurred_Claims 106 number The template calculates this value by subtracting the Projected Risk Adjustments, PMPM from the Projected Incurred Claims, before ACA rein & Risk Adj’t, PMPM.
Projected_Allowed_Experience_Claims_PMPM_Applied_Credibility 107 number The Allowed Claims PMPM is calculated by the template, and is equal to utilization per 1,000 times average cost per service, divided by 12,000. The template sums the PMPM from each Benefit Category to calculate the total PMPM. The calculated PMPM must equal the Allowed Claims PMPM calculated by the template in Section I of Worksheet 1.
Index_Rate_For_Projection_Period 108 number The projected Index Rate
Plan_Product_Submission_Tracking_Number 109 string Tracking number for the rate review submission
System_Generated_MIDAS_Load_Date 110 date (%Y-%m-%d) System Generated load date
Status_Change_Date 111 string System Generated status change date
Submission_Status_Description 112 string Rate review submission status description
Submission_Type 113 string Submission type
Final_Determination 114 string Final determination
Insurance_Product_Rate_Justification 115 string Reason for rate review

datapackage_zip  

This is a preview version. There might be more data in the original version.

Read me

Import into your tool

If you are using R here's how to get the data you want quickly loaded:

install.packages("jsonlite")
library("jsonlite")

json_file <- "http://datahub.io/JohnSnowLabs/health-insurance-plans-unified-rate-review-puf-2015/datapackage.json"
json_data <- fromJSON(paste(readLines(json_file), collapse=""))

# access csv file by the index starting from 1
path_to_file = json_data$resources[[1]]$path
data <- read.csv(url(path_to_file))
print(data)

In order to work with Data Packages in Pandas you need to install the Frictionless Data data package library and the pandas extension:

pip install datapackage
pip install jsontableschema-pandas

To get the data run following code:

import datapackage

data_url = "http://datahub.io/JohnSnowLabs/health-insurance-plans-unified-rate-review-puf-2015/datapackage.json"

# to load Data Package into storage
storage = datapackage.push_datapackage(data_url, 'pandas')

# data frames available (corresponding to data files in original dataset)
storage.buckets

# you can access datasets inside storage, e.g. the first one:
storage[storage.buckets[0]]

For Python, first install the `datapackage` library (all the datasets on DataHub are Data Packages):

pip install datapackage

To get Data Package into your Python environment, run following code:

from datapackage import Package

package = Package('http://datahub.io/JohnSnowLabs/health-insurance-plans-unified-rate-review-puf-2015/datapackage.json')

# get list of resources:
resources = package.descriptor['resources']
resourceList = [resources[x]['name'] for x in range(0, len(resources))]
print(resourceList)

data = package.resources[0].read()
print(data)

If you are using JavaScript, please, follow instructions below:

Install data.js module using npm:

  $ npm install data.js

Once the package is installed, use the following code snippet:

const {Dataset} = require('data.js')

const path = 'http://datahub.io/JohnSnowLabs/health-insurance-plans-unified-rate-review-puf-2015/datapackage.json'

// We're using self-invoking function here as we want to use async-await syntax:
(async () => {
  const dataset = await Dataset.load(path)

  // Get the first data file in this dataset
  const file = dataset.resources[0]
  // Get a raw stream
  const stream = await file.stream()
  // entire file as a buffer (be careful with large files!)
  const buffer = await file.buffer
})()

Install the datapackage library created specially for Ruby language using gem:

gem install datapackage

Now get the dataset and read the data:

require 'datapackage'

path = 'http://datahub.io/JohnSnowLabs/health-insurance-plans-unified-rate-review-puf-2015/datapackage.json'

package = DataPackage::Package.new(path)
# So package variable contains metadata. You can see it:
puts package

# Read data itself:
resource = package.resources[0]
data = resource.read
puts data
Datapackage.json