Plan Attributes PUF - 2014

data.healthcare.gov | Last Updated 11 Dec 2017

The Plan Attributes PUF (Plan-PUF) is one of the seven files that make up the Marketplace PUF. 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 dataset has the following 126 columns:

Column NameAPI Column NameData TypeDescriptionSample Values
Business YearbusinessyeartextYear for which plan provides coverage to enrollees
State CodestatecodetextTwo-character state abbreviation indicating the state where the plan is offered
Issuer IDissueridtextFive-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS)
Source NamesourcenametextCategorical identifier of source of data import
Version NumberversionnumtextInteger value for version of data import
Import Dateimportdatecalendar_dateDate of data import
Benefit Package IDbenefitpackageidtextNumeric identifier of benefit package
Issuer ID (repeated)issuerid2textFive-digit numeric code that identifies the issuer organization in HIOS
State Code (repeated)statecode2textTwo-character state abbreviation indicating the state where the plan is offered
Market CoveragemarketcoveragetextCategorical indicator of market coverage of plan
Dental-Only Plan IndicatordentalonlyplantextCategorical indicator of dental-only status of plan
Tax Identification NumbertintextTax ID Number of issuer
Plan IDstandardcomponentidtextFourteen-character alpha-numeric code that identifies an insurance plan within HIOS
Plan Marketing NameplanmarketingnametextMarketing name of insurance plan
HIOS Product IDhiosproductidtextSeven- character alpha-numeric code that identifies an insurance product within HIOS.
HPID (National Health Plan Identifier)hpidtextIdentifies the insurance product using a National Health Plan Identifier
Network IDnetworkidtextIdentifier for a health care provider network organization
Service Area IDserviceareaidtextIdentifier for a service area
Formulary IDformularyidtextIdentifier for a drug formulary
New/Existing PlanisnewplantextCategorical indicator of whether the insurance plan is new for the current year or existed previously in the marketplace
Plan TypeplantypetextType of insurance plan
Metal LevelmetalleveltextMetal level, or coverage category, of insurance plan based on its actuarial value
Unique Plan DesignuniqueplandesigntextAn indication that the health insurance plan has a unique design, for purposes of the actuarial value calculator
QHP/Non QHPqhpnonqhptypeidtextCategorical indicator of a plan’s exchange marketplace (On the Exchange, Off the Exchange)
Notice Required for PregnancyisnoticerequiredforpregnancytextAn indication of whether notice to the issuer is required before pregnancy-related benefits will be covered
Is a Referral Required for Specialist?isreferralrequiredforspecialisttextAn indication of whether pre-authorization is required before a specialist visit
Specialist Requiring a ReferralspecialistrequiringreferraltextThe types of specialists that require pre-authorization
Plan Level ExclusionsplanlevelexclusionstextThe list of exclusions to the insurance plan that apply to all benefits
Limited Cost Sharing Plan Variation - Estimated Advanced PaymentindianplanvariationestimatedadvancedpaymentamountperenrolleetextEstimated dollar amount of cost–sharing reductions for eligible enrollees to be provided in the form of an advance payment to the issuer
HSA EligibleishsaeligibletextAn indication that the insurance plan qualifies for a health savings account (HSA)
HSA/HRA Employer ContributionhsaorhraemployercontributiontextAn indication that the employer makes an HSA or health reimbursement arrangement (HRA) contribution
HSA/HRA Employer Contribution AmounthsaorhraemployercontributionamounttextThe dollar amount per employee that the employer contributes to the HSA or HRA.
Child-Only OfferingchildonlyofferingtextThe types of child enrollment options (Allows Adult and Child-only, Allows Adult-only, Allows Child-only) of an insurance plan
Child Only Plan IDchildonlyplanidtextThe HIOS Plan Identifier for the child-only insurance plan that corresponds to this insurance plan
Wellness Program OfferedwellnessprogramofferedtextAn indication of whether an insurance plan offers wellness programs according to Section 2705 of the Public Health Service Act
Disease Management Programs OffereddiseasemanagementprogramsofferedtextCategorical indicator of whether the plan offers disease management programs for specific conditions
EHB Apportionment for Pediatric DentalehbpediatricdentalapportionmentquantitytextThe dollar amount of the EHB Apportionment for Pediatric Dental
EHBPercentPremiumS4ehbpercentpremiums4textEHBPercentPremiumS4
Guaranteed RateisguaranteedratetextAn indication of whether the rates for the insurance plan are guaranteed or estimated
Specialty Drug Maximum CoinsurancespecialtydrugmaximumcoinsurancetextThe maximum dollar value of coinsurance for specialty high-cost drugs
Inpatient Copayment Maximum DaysinpatientcopaymentmaximumdaystextThe 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
Begin Primary Care Cost-Sharing After Number Of VisitsbeginprimarycarecostsharingafternumberofvisitstextThe maximum number of fully covered visits allowed, after which primary care cost sharing will begin
Begin Primary Care Deductible Coinsurance After Number Of CopaysbeginprimarycaredeductiblecoinsuranceafternumberofcopaystextThe 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
Plan Effictive Dateplaneffictivedatecalendar_dateThe activation date of enrollment coverage on an Insurance plan
Plan Expiration Dateplanexpirationdatecalendar_dateThe end date of plan selection for enrollment on an Insurance plan
Out of Country CoverageoutofcountrycoveragetextIndicates whether out of country coverage is provided for health services
Out of Country Coverage DescriptionoutofcountrycoveragedescriptiontextThe conditions under which out of country health services are covered
Out of Service Area CoverageoutofserviceareacoveragetextIndicates whether out of service area coverage is provided
Out of Service Area Coverage DescriptionoutofserviceareacoveragedescriptiontextThe conditions under which out of service area health services are covered
National NetworknationalnetworktextIndicates whether the insurance plan is supported by a national network of health service provider companies
URL for Summary of Benefits & CoverageurlforsummaryofbenefitscoveragetextThe URL for the Summary of Benefits & Coverage
URL for Enrollment PaymenturlforenrollmentpaymenttextThe URL for Enrollment Payment
Plan BrochureplanbrochuretextThe URL for the Plan Brochure
FormularyURLformularyurltextFormulary URL
Plan ID (Standard Component ID with Variant)planidtextSeventeen-character alpha-numeric code that identifies an insurance plan’s cost sharing reduction (CSR) variant within HIOS
CSR Variation TypecsrvariationtypetextName of the cost sharing reduction options offered for a health insurance plan
Issuer Actuarial ValueissueractuarialvaluenumberThe numeric actuarial value (AV) generated manually for an insurance plan by the issuer
AV Calculator Output NumberavcalculatoroutputnumbertextThe numeric AV generated by the template’s AV Calculator for an insurance plan
Medical Drug Deductibles IntegratedmedicaldrugdeductiblesintegratedtextAn indication of whether the insurance plan specifies that the medical and drug deductibles are combined into one deductible
Medical Drug Maximum Out of Pocket IntegratedmedicaldrugmaximumoutofpocketintegratedtextAn indication of whether the insurance plan specifies that the medical and drug maximum out of pocket (MOOP) limits are combined into one limit
Multiple In Network TiersmultipleinnetworktierstextAn indication of whether there are two in network tiers
First Tier UtilizationfirsttierutilizationtextThe expected percentage of utilization for the first in network tier
Second Tier UtilizationsecondtierutilizationtextThe expected percentage of utilization for the second in network tier, based on the value entered for the first tier
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individualmehbinntier1individualmooptextThe 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), Familymehbinntier1familymooptextThe 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 2), Individualmehbinntier2individualmooptextThe 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), Familymehbinntier2familymooptextThe 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, Out of Network, IndividualmehboutofnetindividualmooptextThe 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, FamilymehboutofnetfamilymooptextThe 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, Combined In/Out Network, IndividualmehbcombinnoonindividualmooptextThe dollar amount of the combined in/out of network, individual out-of-pocket cost limit for medical EHB benefits
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, FamilymehbcombinnoonfamilymooptextThe dollar amount of the combined in/out of network, family out-of-pocket cost limit for medical EHB benefits
Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individualdehbinntier1individualmooptextThe 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), Familydehbinntier1familymooptextThe 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 2), Individualdehbinntier2individualmooptextThe 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), Familydehbinntier2familymooptextThe 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, Out of Network, IndividualdehboutofnetindividualmooptextThe 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, FamilydehboutofnetfamilymooptextThe 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, Combined In/Out Network, IndividualdehbcombinnoonindividualmooptextThe dollar amount of the combined in/out of network, individual out-of-pocket cost limit for drug EHB benefits
Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, FamilydehbcombinnoonfamilymooptextThe dollar amount of the combined in/out of network, family out-of-pocket cost limit for drug EHB benefits
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individualtehbinntier1individualmooptextThe 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), Familytehbinntier1familymooptextThe 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 2), Individualtehbinntier2individualmooptextThe 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), Familytehbinntier2familymooptextThe 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), Out of Network, IndividualtehboutofnetindividualmooptextThe 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, FamilytehboutofnetfamilymooptextThe 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), Combined In/Out Network, IndividualtehbcombinnoonindividualmooptextThe dollar amount of the combined in/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), Combined In/Out Network, FamilytehbcombinnoonfamilymooptextThe dollar amount of the combined in/out of network, family out-of-pocket cost limit for medical and drug EHB benefits
Medical EHB Deductible, In Network (Tier 1), Individualmehbdedinntier1individualtextThe dollar amount of the tier 1 in network, individual deductible for medical EHB benefits
Medical EHB Deductible, In Network (Tier 1), Familymehbdedinntier1familytextThe dollar amount of the tier 1 in network, family deductible for medical EHB benefits
Medical EHB Deductible, In Network (Tier 1), Default Coinsurancemehbdedinntier1coinsurancetextThe 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 2), Individualmehbdedinntier2individualtextThe dollar amount of the tier 2 in network, individual deductible for medical EHB benefits
Medical EHB Deductible, In Network (Tier 2), Familymehbdedinntier2familytextThe dollar amount of the tier 2 in network, family deductible for medical EHB benefits
Medical EHB Deductible, In Network (Tier 2), Default Coinsurancemehbdedinntier2coinsurancetextThe 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, Out of Network, IndividualmehbdedoutofnetindividualtextThe dollar amount of the out of network, individual deductible for medical EHB benefits
Medical EHB Deductible, Out of Network, FamilymehbdedoutofnetfamilytextThe dollar amount of the out of network, family deductible for medical EHB benefits
Medical EHB Deductible, Combined In/Out of Network, IndividualmehbdedcombinnoonindividualtextThe dollar amount of the combined in/out of network, individual deductible for medical EHB benefits
Medical EHB Deductible, Combined In/Out of Network, FamilymehbdedcombinnoonfamilytextMedical EHB Deductible, Combined In/Out of Network, Family
Drug EHB Deductible, In Network (Tier 1), Individualdehbdedinntier1individualtextThe dollar amount of the tier 1 in network, individual deductible for drug EHB benefits
Drug EHB Deductible, In Network (Tier 1), Familydehbdedinntier1familytextThe dollar amount of the tier 1 in network, family deductible for drug EHB benefits
Drug EHB Deductible, In Network (Tier 1), Default Coinsurancedehbdedinntier1coinsurancetextThe 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 2), Individualdehbdedinntier2individualtextThe dollar amount of the tier 2 in network, individual deductible for drug EHB benefits
Drug EHB Deductible, In Network (Tier 2), Familydehbdedinntier2familytextThe dollar amount of the tier 2 in network, family deductible for drug EHB benefits
Drug EHB Deductible, In Network (Tier 2), Default Coinsurancedehbdedinntier2coinsurancetextThe 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, Out of Network, IndividualdehbdedoutofnetindividualtextThe dollar amount of the out of network, individual deductible for drug EHB benefits
Drug EHB Deductible, Out of Network, FamilydehbdedoutofnetfamilytextThe dollar amount of the out of network, family deductible for drug EHB benefits
Drug EHB Deductible, Combined In/Out of Network, IndividualdehbdedcombinnoonindividualtextThe dollar amount of the combined in/out of network, individual deductible for drug EHB benefits
Drug EHB Deductible, Combined In/Out of Network, FamilydehbdedcombinnoonfamilytextThe dollar amount of the combined in/out of network, family deductible for drug EHB benefits
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individualtehbdedinntier1individualtextThe dollar amount of the tier 1 in network, individual deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Familytehbdedinntier1familytextThe dollar amount of the tier 1 in network, family deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurancetehbdedinntier1coinsurancetextThe percentage used for the tier 1 in network coinsurance for medical and drug EHB benefits, unless a different coinsurance is listed for a specific benefit
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individualtehbdedinntier2individualtextThe dollar amount of the tier 2 in network, individual deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Familytehbdedinntier2familytextThe dollar amount of the tier 2 in network, family deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurancetehbdedinntier2coinsurancetextThe percentage used for the tier 2 in network coinsurance for medical and drug EHB benefits, unless a different coinsurance is listed for a specific benefit
Combined Medical and Drug EHB Deductible, Out of Network, IndividualtehbdedoutofnetindividualtextThe dollar amount of the out of network, individual deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, Out of Network, FamilytehbdedoutofnetfamilytextThe dollar amount of the out of network, family deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, IndividualtehbdedcombinnoonindividualtextThe dollar amount of the combined in/out of network, individual deductible for medical and drug EHB benefits
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, FamilytehbdedcombinnoonfamilytextThe dollar amount of the combined in/out of network, family deductible for medical and drug EHB benefits
SBC Scenario, Having a Baby, DeductiblesbchavingababydeductibletextThe dollar amount of the deductible for the sample Summary of Benefits & Coverage (SBC) scenario of having a baby
SBC Scenario, Having a Baby, CopaymentsbchavingababycopaymenttextThe dollar amount of the copayment for the sample SBC scenario of having a baby
SBC Scenario, Having a Baby, CoinsurancesbchavingababycoinsurancetextThe dollar amount of the coinsurance for the sample SBC scenario of having a baby
SBC Scenario, Having a Baby, LimitsbchavingababylimittextThe dollar amount of the benefit limits or exclusions for the sample SBC scenario of having a baby
SBC Scenario, Having Diabetes, DeductiblesbchavingdiabetesdeductibletextThe dollar amount of the deductible for the sample SBC scenario of having diabetes
SBC Scenario, Having Diabetes, CopaymentsbchavingdiabetescopaymenttextThe dollar amount of the copayment for the sample SBC scenario of having diabetes
SBC Scenario, Having Diabetes, CoinsurancesbchavingdiabetescoinsurancetextThe dollar amount of the coinsurance for the sample SBC scenario of having diabetes
SBC Scenario, Having Diabetes, LimitsbchavingdiabeteslimittextThe dollar amount of the benefit limits or exclusions for the sample SBC scenario of having diabetes
Row NumberrownumbertextTemplate row number associated with this data record