0990-PLTC File Specifications

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File 1 - Registry File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb Field Name
er

1
2

Company Code
Report Date

Field
Type

N

Field
Field Definition
Length

5
8

3

Reporting Period

N

16

4

Insured’s Social Security Number

N

10

5
6
7
8
9

Policy Number
First Name
Middle Initial
Last Name
Date of Birth

AN
A
A
A
N

30
30
1
40
8

Unique company identifier using NAIC company code. If the
block of business was purchased from another carrier, the
company code of the acquiring company should be provided.
The HHS data repository will develop a unique code for selffunded and FLTCIP plans that do not have NAIC codes.
Date on which the report was submitted to HHS.
Begin date and end date of reporting period. In general, the
reporting period for File 1 will be a six-month period, either
January 1 through June 30, or July 1 through December 31.
Social security number of the person insured under the
Partnership Qualified (PQ) policy.
The unique certificate or policy number assigned by the
carrier
First name of insured
Middle initial in name of insured
Last name of insured
Birth date of insured

Field Values

5 Digit NAIC Code or a uniquely assigned company code for
self-funded plans and Federal Employees Long Term Care
Insurance program (FLTCIP)
Format: MMDDYYYY

Format: MMDDYYYYMMDDYYYY
10 digit numeric code (no dashes)
999999999 if not available
A/N
First Name
Middle Initial
Last name; include generational suffixes here i.e., JR SR
Format: MMDDYYYY
M = Male
F = Female
U = Unknown
Street name and number
Additional Address Line
Insured’s city of residence during reporting period
USPS state code.
5-digit numeric code
9-digit numeric code optional (no hyphen for zip+4).

10
11
12
13
14

Gender
Current Address Line 1
Current Address Line 2
Current City of Residence
Current State

A
AN
AN
A
A

1
50
50
40
2

Gender of insured
Insured's current street address
Insured's current street address line 2
Insured’s current city of residence
Insured’s current state of residence

15

Current ZIP Code

N

9

16

Policy Issue State

A

2

Postal zip code of insured’s current residence
State in which the individual or group policy was originally
issued.

2

For group business, this is the original residence state. The
state where the certificateholder lived at the time of original
purchase.

USPS state code.

6

The current annualized premium for the policy/certificate.

Numeric code without commas, decimals or dollar signs.
The premium amount may be zero for policies in waiver of
premium, in a paid up status or in nonforfeiture status.

8

Indicates date on which the insured’s coverage first became
effective as a PQ policy under his or her individual policy or
group certificate. Based on each state’s rules for exchanges,
this could be a date prior to the date on which the exchange
Format: MMDDYYYY
takes place.

17

18

19

Certificate Issue State

Current Annual Premium

Original Coverage Effective Date as
Partnership Qualified (PQ) Policy

A

N

N

USPS state code.

File 1 - Registry File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb Field Name
er

20

21

22

23

Policy Exchange to PQ

Policy Benefit Type

Coverage Basis

Ported Coverage from Group to Individual
Policy

Field
Type

N

A

A

N

Field
Field Definition
Length

Field Values

1

Indicates whether the policy is a PQ policy as a result of an
exchange from a non-PQ policy, rather than as an original
purchase.

2

CP = Comprehensive
NH = Nursing Home Only
FC = Facility Care Only (includes NH and ALF)
HC = Home Health Care Only
Indicates the major type of benefits allowed under the policy. OT = Other

1

Indicates whether the policy is a group or an individual policy.
For multi-life groups, the value selected should be based on G = Group Policy
how the policy was filed with the Department of Insurance.
I = Individual Policy

1

Indicates whether the policy was originally purchased on a
group basis, and then coverted to an individual policy at a
later date (e.g. when the insured individual left his or her
employer where the coverage was originally purchased).

1 = Yes
0 = No
S = Single lifetime maximum for all covered services
(although there may be inner limits on some benefits
provided over and above the lifetime maximum)
M = Multiple lifetime maximums by covered service (one or
more)
DL = Dollars (pool(s) of dollars design)
DY = Days and not pool of dollars design

1 = Yes
0 = No

24

Lifetime Maximum Structure

A

1

25

Lifetime Maximum Structure Detail

A

2

Indicates whether the Lifetime Maximum is expressed as a
single benefit pool across all covered services (Integrated
Lifetime Maximum) or whether there are separate Lifetime
Maximums for two or more covered benefits.
Indicates whether the policy counts Dollars or Days of
benefits used as the Lifetime Maximum.

9

Indicates the whole dollar amount of the Policy Lifetime
Maximum for Nursing Home Benefits, or indicates an
“unlimited” Policy Lifetime Maximum. Nearest whole dollar
amount.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days

9

If policy has multiple pools and pays in dollars, this field
indicates the current dollar amount of the Lifetime Policy
Maximum for Home Health Care Benefits, or indicates an
“unlimited” Lifetime Maximum. Nearest whole dollar
amount.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days
888888888 = Policy/certificate only has one pool

9

If policy has multiple pools and pays in dollars, this field
Numeric value without commas, decimals or dollar signs.
indicates the current dollar amount of the Lifetime Policy
000000000 = Lifetime/Unlimited
Maximum for ALF/Other Facility Benefits, or indicates an
999999999 = Pool maximum expressed in days
“unlimited” Lifetime Maximum. Nearest whole dollar amount. 888888888 = Policy/certificate only has one or two pools

5

If the policy has multiple pools, with day limits on individual
Numeric value without commas or decimals.
pools, this field indicates the current Lifetime Policy Maximum 00000 = Unlimited
for number of days of Nursing Home Coverage.
99999 = Pool maximum expressed in dollars

26

27

Lifetime Policy Maximum for Nursing
Home Coverage (Dollars)

N

Lifetime Policy Maximum for Home Health
N
Care (Dollars)

28

Lifetime Policy Maximum for ALF/Other
Facility Care (Dollars)

29

Lifetime Policy Maximum for Nursing
Home Benefits (Days)

N

N

File 1 - Registry File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb Field Name
er

30

31

32

33

34

35

Field
Type

Lifetime Policy Maximum for Home Health
N
Care Benefits (Days)

Lifetime Policy Maximum for ALF/Other
Facility Care Benefits (Days)

Nursing Home Benefit Amount

Home Health Care Benefit Amount

Assisted Living Facility (ALF) Benefit
Amount

Automatic Inflation Protection Type

N

N

N

N

A

Field
Field Definition
Length

Field Values

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the current lifetime maximum
number of Home Health Care days.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum expressed in dollars
88888 = Policy/certificate only has one pool

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the lifetime maximum number of
ALF/Other Facility days covered.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum expressed in dollars
88888 = Policy/certificate only has one or two pools

4

The current daily benefit amount for nursing home coverage.
If the benefit is paid as weekly or monthly, the daily amount
can be derived. If the policyholder has inflation protection,
Numeric value without commas, decimals or dollar signs.
this field should reflect the current daily benefit amount, as
0000 = Unlimited daily benefit amount
inflated.
8888 = No Nursing Home Benefit

4

The current daily benefit amount for Home Health Care
provision on the policy. If the benefit is paid as weekly or
monthly, the daily amount should be derived. If the
policyholder has inflation protection, this field should reflect
the current daily benefit amount, as inflated.

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No Home Health Care Benefit

4

The current daily benefit amount for Assisted Living
Facility/Other Facility Care. If the benefit is paid as weekly
or monthly, the daily amount should be derived. If the
policyholder has inflation protection, this field should reflect
the current daily benefit amount, as inflated.

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No ALF Benefit

Indicates the type of inflation protection provided in the
policy.

ABI = Automatic annual compound inflation protection,
funded on level issue-age basis
ASI = Automatic annual simple inflation protection, funded on
level issue-age basis
GIP = Graded inflation protection; both benefits and
premiums increase by specified amount each year
SIP = Step-rated design where nature of inflation protection
changes over time or at certain attained ages
CPI = General consumer price index
LCI = Long Term Care specific consumer price index
OTI = Other price index value
CDI = Carrier determined index
OTH = Other (but not to include FPO/GPO/BIO, see below)
NIP = No inflation protection

3

File 1 - Registry File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb Field Name
er

Field
Type

Field
Field Definition
Length

N

If the annual increase is tied to an index, as indicated in field
# 35, apply the current index value.
This field provides the annual increase percentage of inflation Percentage value with two decimal points (e.g., 02.50)
protection provided in the policy (e.g., 2%, 3%, 5%). If the
88.88 = If field 35 equals NIP
annual increase is tied to an index, as indicated in field # 35, 99.99 = No annual inflation amount
5 (2.2) apply the current index value.

37

Inflation Protection Duration: Attained Age
N
of Insured

1

1=Yes, inflation protection stops at an attained age
0=No, inflation protection does not stop at an attained age
Indicates if automatic inflation protection stops at an attained If field 35 = NIP or there is no limit on inflation protection, this
age of the insured.
field may be zero-filled.

38

Attained Age at Which Inflation Protection
Ends

3

Indicates attained age of insured when automatic inflation
protection ends.

Numeric value in years
If field 35 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protections stops at an
attained age of the policy/certificate.

1=Yes, inflation protection stops at an attained age of the
Policy/Certificate
0=No, inflation protection does not stop at an attained age of
the Policy/Certificate
If field 35 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Numeric value in years
Indicates the attained age of policy/certificate when automatic If field 35 = NIP or there is no limit on inflation protection, this
inflation protection ends.
field may be zero-filled.

1

Indicates if automatic inflation projection continues for the
entire duration of the policy/certificate.

1=Yes, inflation protection continues for entire duration of the
policy/certificate
0=No, inflation protection does not continue for the entire
duration of the policy/certificate

1

Indicates if automatic inflation protection ends when the
benefit has doubled.

1=Yes, inflation protection ends when benefit has doubled
0=No, inflation protection does not end when benefit has
doubled
If field 35 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protection ends by some
trigger other than the triggers described in fields 37, 39, or
42.

1=Yes, inflation protection ends by some other trigger
0=No, inflation protection does not end by a trigger
If field 35 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Indicates if the insured has elected or automatically has a
Future Purchase Option (FPO) as a provision of their policy
or certificate and the type of FPO structure.

YA = Annual FPO
YV = FPO, but not Annual
NO = No FPO

2

1 = Annual FPO
Other numeric value for non-annual FPO offers
Indicates the frequency (in years) with which the FPO offer is (e.g. 2 for every 2 years)
made to the insured.
0 = No FPO

36

Inflation Protection Increase Amount or
Index Value

N

39

Inflation Protection Duration: Attained Age
N
of Policy/Certificate

40

Policy/Certificate Age at Which Inflation
Protection Ends

41

42

43

44

45

Inflation Protection Duration Type: Life of
Policy/Certificate

Inflation Protection Duration Type: When
Benefit has Doubled

Inflation Protection Duration Type: Other
Trigger Type

Future Purchase Option

Frequency of Future Purchase Option

N

N

N

N

A

N

Field Values

File 1 - Registry File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb Field Name
er

46

47

48

Termination of FPO Option

Policy Status at End of Reporting Period

Partnership Status

Field
Type

A

A

A

Field
Field Definition
Length

2

Field Values

LT = Offers continue for the life of the policy
D1 = 1 decline triggers termination of offers
D2 = 2 declines trigger termination of offers
C2 = Offers end with 2 consecutive declines
AG = Offers end at specified age
CL = Insured goes into claim
Indicates circumstances, if any, under which Future Purchase OT = Other means of ending the offers
Option ends
NO = No FPO

1

Indicate the status of the PQ policy at the end date of the
current reporting period. Note that values E, V, R, D and O
would only be reported if that status was obtained at some
point during the current reporting period.

I = Inforce
N = Active in non-forfeiture
E = Exhausted benefits
V = Voluntary Lapse
R = Recission
D = Death
T = Not Taken Out (NTO)
O = Other

2

Indicates if the policy remains Partnership Qualified at the
end of the reporting period. NQ should only be reported
once, since persons without PQ policies would be dropped
from File 1 in subsequent reporting periods.

PQ=Partnership Qualified
NQ=No longer Partnership Qualified

File 2 - Claimant File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb
Field Name
er

1
2

Company Code
Report Date

Field
Type

N

Field
Length Field Definition

5
8

3

Reporting Period

N

16

4

Claimant Social Security Number

N

10

5
6
7
8
9

Policy Number
First Name
Middle Initial
Last Name
Date of Birth

AN
A
A
A
N

30
30
1
40
8

10

Qualifying Condition

12

Benefit Start Date of the Current Claim
Period
Nursing Home Benefits Paid During
Reporting Period

13

Home Health Care Benefits Paid During
Reporting Period

11

Unique company identifier using NAIC company code. If the
block of business was purchased from another carrier, the
company code of the acquiring company should be provided.
The HHS data repository will develop a unique code for selffunded and FLTCIP plans that do not have NAIC codes.
Date on which the report was submitted to HHS.

5 Digit NAIC Code or a uniquely assigned company code for
self-funded plans and Federal Employees Long Term Care
Insurance program (FLTCIP)
Format: MMDDYYYY

Begin date and end date of reporting period. In general, the
reporting period for File 2 will be a calendar year quarter (e.g.
Format: MMDDYYYYMMDDYYYY
January 1 to March 31)
10 digit numeric code (no dashes)
Social security number of insured claimant.
999999999 if not available
The unique certificate or policy number assigned by the
Any alphanumeric combination as determined by the carrier.
carrier.
First name of insured
First Name
Middle initial in name of insured
Middle Initial
Last name of insured
Last name
Birth date of insured
Format: MMDDYYYY

A

1

N

8

N

9

Indicates whether claimant became eligible for benefits
based on ADL deficits, Cognitive Impairment, Both ADL and
Cognitive Impairments, or some other benefit trigger.
Indicates date on which benefit payments begin for the
current claim period. This date should occur after any
elimination period has been satisfied.
Indicates the total amount of benefits for nursing home
services paid during the current reporting period.

9

Indicates the total amount of benefits paid during the
reporting period for home health care and related home
health care services.

N

Field Values

A = ADL Dependency
C = Cognitive Impairment
B = ADL and Cognitive Impairment
O = Other Benefit Eligibility Trigger(s)
Format: MMDDYYYY
Numeric value (in dollars) rounded to the nearest dollar
amount.
Numeric value (in dollars) rounded to the nearest dollar
amount.

15

Assisted Living/Other Facility Benefits Paid
N
During Reporting Period
Total Cash Benefits Paid During Reporting
N
Period

16

Other Benefit Amounts Paid During
Reporting Period

N

9

17

Total Lifetime Benefits Paid to Date

N

9

Indicates the total amount of benefits paid during the
reporting period for assisted living or other non-nursing home Numeric value (in dollars) rounded to the nearest dollar
facility care.
amount.
Indicates the total amount of benefits paid during the
Numeric value (in dollars) rounded to the nearest dollar
reporting period for cash benefits.
amount.
Indicates the total amount of benefits paid during the
reporting period for all benefits paid other than nursing home,
home and community care, assisted living/other facility care, Numeric value (in dollars) rounded to the nearest dollar
or cash benefits.
amount.
Indicates the total amount of benefits paid under the
Numeric value (in dollars) rounded to the nearest dollar
certificate to date as of the end of the reporting period.
amount.

9

Indicates the total amount of benefits remaining under the
lifetime maximum (for all pools combined) as of the end of
the reporting period.

14

18

Remaining Lifetime Benefits for all Pools
Combined (Dollars)

N

9
9

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime benefit expressed in days

File 2 - Claimant File
For Individual and Voluntary or Partially Voluntary Group Coverage
Field
Numb
Field Name
er

19

20

21

22

23

24

Remaining Lifetime Nursing Home
Benefits (Dollars)

Remaining Lifetime Home Health Care
Benefits (Dollars)

Remaining Lifetime ALF/Other Facility
Benefits (Dollars)

Remaining Lifetime Nursing Home
Benefits (Days)

Remaining Lifetime Home Health Care
Benefits (Days)

Remaining Lifetime ALF/Other Facility
Care Benefits (Days)

Field
Type

N

N

N

N

N

N

Field
Length Field Definition

Field Values

9

Indicates the total amount of nursing home benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for nursing home benefits is
expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime benefit expressed in days

9

Indicates the total amount of home health care benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for home health care benefits is
expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime maximum expressed in days
888888888 = No second pool

9

Indicates the total amount of ALF/Other Facility Benefits
benefits remaining in the policy as of the end of the reporting
period, if the lifetime maximum for home health care benefits
is expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime maximum expressed in days
888888888 = No third pool

5

Indicates the total amount of nursing home benefits
remaining for the policy as of the end of the reporting period, Numeric value (in days).
if the lifetime maximum for nursing home benefits is
00000 = Unlimited Lifetime Benefits
expressed in days.
99999 = Pool maximum expressed in dollars

5

Indicates the total amount of home health care benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for home health care benefits is
expressed in days.

5

Indicates the total amount of ALF/Other Facility benefits
Numeric value (in days).
remaining in the policy as of the end of the reporting period, if 00000 = Unlimited Lifetime Benefits
the lifetime maximum for ALF/Other Facility benefits is
99999 = Pool maximum expressed in dollars
expressed in days.
88888 = No third pool

Numeric value (in days).
00000 = Unlimited Lifetime Benefits
99999 = Pool maximum expressed in dollars
88888 = No second pool

File 3 - Registry File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

1 Company Code
2 Report Date

3 Reporting Period

4 Employer Name
5 Employer Type
Number of Persons Insured with Core
6 Coverage

7 Situs State

8 Employer Street Address 1

Field
Type

N

N

A

Field
Field Definition
Length

5
8

Unique company identifier using NAIC company code. If the
block of business was purchased from another carrier, the
company code of the acquiring company should be provided.
The HHS data repository will develop a unique code for selffunded and FLTCIP plans that do not have NAIC codes.
Date on which the report was submitted to HHS.

16

Begin date and end date of reporting period. In general, the
reporting period for File 3 will be a calendar year (e.g.
Format: MMDDYYYYMMDDYYYY
January 1 through December 31)

60

Indicates name of employer. If employer offers more than
one plan type (e.g. to different classifications of employees),
different plan types will be indicated by Employer Name A,
Employer Name B, etc.

2
N

A

AN

Field Values

5 Digit NAIC Code or a uniquely assigned company code for
self-funded plans and Federal Employees Long Term Care
Insurance program (FLTCIP)
Format: MMDDYYYY

Name

6

Indicates the type of employer using standard industry codes Two digit industry code
Indicate number of insureds covered under the employers
Numeric value with no commas or decimals
core plan

2

Indicate the two-letter USPS code for state in which the
group policy is sitused. If an individual policy form is being
used, indicate N/A

50

Indicate employer primary address, line 1. This address
should be the primary address where the carrier corresponds
Employer street address
with the employer regarding the group plan.

USPS state code
NA = An individual policy form is being used

9 Employer Street Address 2
10 Employer City
11 Employer State

AN
A
A

50
40
2

12 Employer ZIP Code

N

9

Indicate employer primary address, line 2. This address
should be the primary address where the carrier corresponds
with the employer regarding the group plan. Same as above Employer street address - additional address line
Employer address: City
City Name
Employer address: State
USPS state code
5-digit numeric code
Postal zip code of employer’s address
9-digit numeric code optional (no hyphen for zip+4).

2

CP = Comprehensive
NH = Nursing Home Only
FC = Facility Care Only (includes NH and ALF)
HC = Home Health Care Only
Indicates the major type of benefits allowed under the policy. OT = Other

13 Core Coverage Policy Benefit Type

A

14 Core Coverage Basis

A

1

15 Average Monthly Premium Amount

N

9

Indicates whether the policy is a group or an individual policy.
For multi-life groups, the value selected should be based on G = Group Policy
how the policy was filed with the Department of Insurance.
I = Individual Policy
Indicates average monthly premium amount paid by the
Numeric value (in dollars) rounded to the nearest dollar
employer for each insured covered under the core plan
amount.

File 3 - Registry File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Field
Type

Field
Field Definition
Length

Field Values
S = Single lifetime maximum for all covered services
(although there may be inner limits on some benefits
provided over and above the lifetime maximum)
M = Multiple lifetime maximums by covered service (one or
more)
DL = Dollars (pool(s) of dollars design)
DY = Days and not pool of dollars design

16 Core Lifetime Maximum Structure

A

1

17 Core Lifetime Maximum Structure Detail

A

2

Indicates whether the Lifetime Maximum is expressed as a
single benefit pool across all covered services (Integrated
Lifetime Maximum) or whether there are separate Lifetime
Maximums for two or more covered benefits.
Indicates whether the policy counts Dollars or Days of
benefits used as the Lifetime Maximum.

9

Indicates the whole dollar amount of the Core Policy Lifetime Numeric value without commas, decimals or dollar signs.
Maximum for Nursing Home Benefits, or indicates an
000000000 = Lifetime/Unlimited
“unlimited” Policy Lifetime Maximum.
999999999 = Pool maximum expressed in days

9

If the policy has multiple pools and pays in dollars, this field
indicates the current dollar amount of the Lifetime Policy
Maximum for Home Health Care Benefits, or indicates an
“unlimited” Lifetime Maximum.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days
888888888 = Policy/certificate only has one pool

9

If the policy has multiple pools and pays in dollars, this field
indicates the current dollar amount of the Lifetime Policy
Maximum for ALF/Other Facility Benefits, or indicates an
“unlimited” Lifetime Maximum.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days
888888888 = Policy/certificate only has one or two pools

5

If the policy has multiple pools, with day limits on individual
Numeric value without commas or decimals.
pools, this field indicates the current Lifetime Policy Maximum 00000 = Unlimited
for number of days of Nursing Home Coverage.
99999 = Pool maximum expressed in dollars

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the current lifetime maximum
number of Home Health Care days.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum is calculated in dollars
88888 = Policy/certificate only has one pool

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the lifetime maximum number of
ALF/Other Facility days covered.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum is calculated in dollars
88888 = Policy/certificate only has one or two pools

4

The current daily benefit amount for nursing home coverage.
If the benefit is paid as weekly or monthly, the daily amount
should be derived. If the policy has inflation protection, this
Numeric value without commas, decimals or dollar signs.
field should reflect the current daily benefit amount, as
0000 = Unlimited daily benefit amount
inflated.
8888 = No Core Nursing Home Benefit

4

The current daily benefit amount for home health care
provision on the policy. If the benefit is paid as weekly or
monthly, the daily amount should be derived. If the policy
has inflation protection, this field should reflect the current
daily benefit amount, as inflated.

Core Lifetime Policy Maximum for Nursing
18 Home Coverage (Dollars)
N

Core Lifetime Policy Maximum for Home
19 Health Care (Dollars)

Core Lifetime Policy Maximum for
20 ALF/Other Facility Care (Dollars)

N

N

Core Lifetime Policy Maximum for Nursing
21 Home Benefits (Days)
N

Core Lifetime Policy Maximum for Home
22 Health Care Benefits (Days)

Core Lifetime Policy Maximum for
23 ALF/Other Facility Care Benefits (Days)

24 Core Nursing Home Benefit Amount

25 Core Home Health Care Benefit Amount

N

N

N

N

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No Core Home Health Care Benefit

File 3 - Registry File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Field
Type

Core Assisted Living Facility (ALF) Benefit
26 Amount
N

27 Core Automatic Inflation Protection Type

A

Field
Field Definition
Length

4

3

Field Values

The current daily benefit amount for Assisted Living
Facility/Other Facility Care. If the benefit is paid as weekly
or monthly, the daily amount should be derived. If the
policyholder has inflation protection, this field should reflect
the current daily benefit amount, as inflated.

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No Core ALF Benefit

Indicates the type of inflation protection provided in the
policy.

ABI = Automatic annual compound inflation protection,
funded on level issue-age basis
ASI = Automatic annual simple inflation protection, funded on
level issue-age basisfunded on level issue-age basis
GIP = Graded inflation protection; both benefits and
premiums increase by specified amount each year
SIP = Step-rated design where nature of inflation protection
changes over time or at certain attained ages
CPI = General consumer price index
LCI = Long Term Care specific consumer price index
OTI = Other price index value
CDI = Carrier determined index
OTH = Other (but not to include FPO/GPO/BIO, see below)
NIP = No inflation protection

Core Inflation Protection Increase Amount
28 or Index Value
N

If the annual increase is tied to an index, as indicated in field
This field provides the annual increase percentage of inflation # 27, apply the current index value.
protection provided in the policy (e.g., 2%, 3%, 5%). If the
Percentage value with two decimal points (e.g. 02.50)
annual increase is tied to an index, as indicated in field # 27, 99.99 = No annual inflation amount
5 (2.2) apply the current index value.
88.88 = If field 27 equals NIP

Core Inflation Protection Duration: Attained
29 Age of Insured
N

1

1=Yes, inflation protection stops at an attained age
0=No, inflation protection does not stop at an attained age
Indicates if automatic inflation protection stops at an attained If field 27 = NIP or there is no limit on inflation protection, this
age of the insured.
field may be zero-filled.

3

Attained age of insured when automatic inflation protection
ends.

Numeric value in years
If field 27 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protections end at an attained
age for the policy/certificate.

1=Yes, inflation protection stops at an attained age of the
Policy/Certificate
0=No, inflation protection does not stop at an attained age of
the Policy/Certificate
If field 27 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Attained age of policy/certificate when automatic inflation
protection ends.

Numeric value in years
If field 27 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

Core Attained Age at Which Inflation
30 Protection Ends

N

Core Inflation Protection Duration: Attained
31 Age of Policy/Certificate
N
Core Policy/Certificate Age at Which
32 Inflation Protection Ends

N

File 3 - Registry File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Core Inflation Protection Duration Type:
33 Life of Policy/Certificate

Core Inflation Protection Duration Type:
34 When Benefit has Doubled

Core Inflation Protection Duration Type:
35 Other Trigger Type

36 Partnership Status of Core Coverage

37 Buy-Up Option Available
Number of Insureds with Buy-Up PQ
38 Coverage
Group Policy Status at End of Reporting
39 Period

40 Active Claim Status

Field
Type

N

N

N

A

N

Field
Field Definition
Length

Field Values

Indicates if automatic inflation projection continues for the
entire duration of the policy/certificate.

1=Yes, inflation protection continues for entire duration of the
policy/certificate
0=No, inflation protection does not continue for the entire
duration of the policy/certificate

1

Indicates if automatic inflation protection ends when the
benefit has doubled.

1 = Yes, inflation protection ends when benefit has doubled
0 = No, inflation protection does not end when benefit has
doubled
If field 27 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protection ends by some
trigger other than the triggers described in fields 29, 31, or
34.

1 = Yes, inflation protection ends by some other trigger
0 = No, inflation protection does not end by a trigger
If field 27 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Indicates if the core coverage provided by the employer-paid
group policy is PQ in at least one or more states covered by
the policy, or if the core coverage provided under the plan is PQ=Core Coverage is Partnership Qualified
not PQ in any state.
NQ = Core Coverage Not Partnership Qualified

1

Indicates whether employees are eligible to purchase
additional coverage on their own to supplement the
employer-paid portion (core plan)

1 = Yes
0 = No

Numeric value with not commas or decimals
S=Still in Force
T=Terminated

1

N

6

A

1

Indicates the number of insureds who have elected to “buyup” to coverage such that they have Partnership-qualified
plans
Indicates if group policy is still in force or if it has terminated
since the prior reporting period.

1

Indicates whether any claims are being or have been paid on
behalf of insureds covered under the employer-paid core
plan. If YES, insurer completes and submits File 4 for each 1 = Yes
insured for whom benefits have been paid.
0 = No

N

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

1 Company Code
2 Report Date

Field
Type

N

Field
Field Definition
Length

5
8

3 Reporting Period

N

16

4 Claimant Social Security Number

N

10

5 Policy Number
6 First Name
7 Middle Initial
8 Last Name
9 Date of Birth

AN
A
A
A
N

30
30
1
40
8

Unique company identifier using NAIC company code. If the
block of business was purchased from another carrier, the
company code of the acquiring company should be provided.
The HHS data repository will develop a unique code for selffunded and FLTCIP plans that do not have NAIC codes.
Date on which the report was submitted to HHS.

Field Values

5 Digit NAIC Code or a uniquely assigned company code for
self-funded plans and Federal Employees Long Term Care
Insurance program (FLTCIP)
Format: MMDDYYYY

Begin date and end date of reporting period. In general, the
reporting period for File 4 will be a calendar year quarter (e.g.
Format: MMDDYYYYMMDDYYYY
January 1 to March 31)
10 digit numeric code (no dashes)
Social security number of insured claimant.
999999999 if not available
The unique certificate or policy number assigned by the
carrier.
Any alphanumeric combination as determined by the carrier.
First name of insured
First Name
Middle initial in name of insured
Middle Initial
Last name of insured
Last name; include generational suffixes here i.e., JR SR
Birth date of insured
Format: MMDDYYYY
M = Male
F = Female
U = Unknown
Street name and number
Additional Address Line
Insured’s city of residence during reporting period
USPS state code.
5-digit numeric code
9-digit numeric code optional (no hyphen for zip+4).

10 Gender
11 Current Address Line 1
12 Current Address Line 2
13 Current City of Residence
14 Current State

A
AN
AN
A
A

1
50
50
40
2

Gender of insured
Insured's current street address
Insured's current street address line 2
Insured’s current city of residence
Insured’s current state of residence

15 Current ZIP Code

N

9

16 Policy Issue State

A

2

Postal zip code of insured’s current residence
State in which the individual or group policy was originally
issued.

2

For group business, this is the original residence state. The
state in which the certificateholder lived at the time of original
USPS state code.
purchase.

17 Certificate Issue State

18 Current Annual Premium

Original Coverage Effective Date as
19 Partnership Qualified (PQ) Policy

A

N

N

USPS state code.

Numeric code without commas, decimals or dollar signs.
The premium amount may be zero for policies in waiver of
premium, in a paid up status or in nonforfeiture status.

6

The current annualized premium for the policy/certificate.

8

Indicates date on which the insured’s coverage first became
effective as a PQ policy under his or her individual policy or
group certificate. Based on each state’s rules for exchanges,
this could be a date prior to the date on which the exchange
Format: MMDDYYYY
takes place.

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

20 Policy Exchange to PQ

21 Policy Benefit Type

22 Coverage Basis

Field
Type

Field
Field Definition
Length

N

1

Indicate whether the policy is PQ as a result of an exchange
from a non-PQ policy, rather than as an original purchase.

2

CP = Comprehensive
NH = Nursing Home Only
FC = Facility Care Only (includes NH and ALF)
HC = Home Health Care Only
Indicates the major type of benefits covered under the policy. OT = Other

1

Indicates whether the policy is a group or an individual policy.
For multi-life groups, the value selected should be based on G = Group policy
how the policy was filed with the Department of Insurance.
I = Individual policy

S = Single lifetime maximum for all covered services
(although there may be inner limits on some benefits
provided over and above the lifetime maximum)
M = Multiple lifetime maximums by covered service (one or
more)

A

A

Field Values

1 = Yes
0 = No

23 Lifetime Maximum Structure

A

1

Indicates whether the Lifetime Maximum is expressed as a
single benefit pool across all covered services (Integrated
Lifetime Maximum) or whether there are separate Lifetime
Maximums for two or more covered benefits.

24 Lifetime Maximum Structure Detail

A

2

Indicates whether the policy counts Dollars or Days of
benefits used as the Lifetime Maximum.

DL = Dollars (pool(s) of dollars design)
DY = Days and not pool of dollars design

9

Indicates the whole dollar amount of the Policy Lifetime
Maximum for Nursing Home Benefits, or indicates an
“unlimited” Policy Lifetime Maximum.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days

9

If policy has multiple pools and pays in dollars, this field
indicates the current dollar amount of the Lifetime Policy
Maximum for Home Health Care Benefits, or indicates an
“unlimited” Lifetime Maximum.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days
888888888 = Policy/certificate only has one pool

Lifetime Policy Maximum for Nursing
25 Home Coverage (Dollars)

N

Lifetime Policy Maximum for Home Health
26 Care (Dollars)
N

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Lifetime Policy Maximum for ALF/Other
27 Facility Care (Dollars)

Lifetime Policy Maximum for Nursing
28 Home Benefits (Days)

Field
Type

N

N

Lifetime Policy Maximum for Home Health
29 Care Benefits (Days)
N

Lifetime Policy Maximum for ALF/Other
30 Facility Care Benefits (Days)

31 Nursing Home Benefit Amount

32 Home Health Care Benefit Amount

Assisted Living Facility (ALF) Benefit
33 Amount

N

N

N

N

Field
Field Definition
Length

Field Values

9

If policy has multiple pools and pays in dollars, this field
indicates the current dollar amount of the Lifetime Policy
Maximum for ALF/Other Facility Benefits, or indicates an
“unlimited” Lifetime Maximum.

Numeric value without commas, decimals or dollar signs.
000000000 = Lifetime/Unlimited
999999999 = Pool maximum expressed in days
888888888 = Policy/certificate only has one or two pools

5

If the policy has multiple pools, with day limits on individual
Numeric value without commas or decimals.
pools, this field indicates the current Lifetime Policy Maximum 00000 = Unlimited
for number of days of Nursing Home Coverage.
99999 = Pool maximum expressed in dollars

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the current lifetime maximum
number of Home Health Care days.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum expressed in dollars
88888 = Policy/certificate only has one pool

5

If the policy has multiple pools, with day limits on individual
pools, this field indicates the lifetime maximum number of
ALF/Other Facility days covered.

Numeric value without commas or decimals.
00000 = Unlimited
99999 = Pool maximum expressed in dollars
88888 = Policy/certificate only has one or two pools

4

The current daily benefit amount for nursing home coverage.
If the benefit is paid as weekly or monthly, the daily amount
can be derived. If the policyholder has inflation protection,
Numeric value without commas, decimals or dollar signs.
this field should reflect the current daily benefit amount, as
0000 = Unlimited daily benefit amount
inflated.
8888 = No Core Nursing Home Benefit

4

The current daily benefit amount for home health care
provision on the policy. If the benefit is paid as weekly or
monthly, the daily amount should be derived. If the
policyholder has inflation protection, this field should reflect
the current daily benefit amount, as inflated.

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No Core Home Health Care Benefit

4

The current daily benefit amount for Assisted Living
Facility/Other Facility Care. If the benefit is paid as weekly
or monthly, the daily amount should be derived. If the
policyholder has inflation protection, this field should reflect
the current daily benefit amount, as inflated.

Numeric value without commas, decimals or dollar signs.
0000 = Unlimited daily benefit amount
8888 = No Core ALF Benefit

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

34 Automatic Inflation Protection Type

Inflation Protection Increase Amount or
35 Index Value

Field
Type

A

N

Inflation Protection Duration: Attained Age
36 of Insured
N
Attained Age at Which Inflation Protection
37 Ends

N

Inflation Protection Duration: Attained Age
38 of Policy/Certificate
N

Policy/Certificate Age at Which Inflation
39 Protection Ends

Inflation Protection Duration Type: Life of
40 Policy/Certificate

N

N

Field
Field Definition
Length

Field Values

ABI = Automatic annual compound inflation protection,
funded on level issue-age basis
ASI = Automatic annual simple inflation protection, funded on
level issue-age basis
GIP = Graded inflation protection; both benefits and
premiums increase by specified amount each year
SIP = Step-rated design where nature of inflation protection
changes over time or at certain attained ages
CPI = General consumer price index
LCI = Long Term Care specific consumer price index
OTI = Other price index value
CDI = Carrier determined index
OTH = Other (but not to include FPO/GPO/BIO, see below)
NIP = No inflation protection

3

Indicates the type of inflation protection provided in the
policy.

5

If the annual increase is tied to an index, as indicated in field
This field provides the annual increase percentage of inflation # 34, apply the current index value.
protection provided in the policy (e.g., 2%, 3%, 5%). If the
Percentage value with two decimal points (e.g. 02.50)
annual increase is tied to an index, as indicated in field #34, 99.99 = No annual inflation amount
apply the current index value.
88.88 = If field 34 equals NIP

1

1=Yes, inflation protection stops at an attained age
0=No, inflation protection does not stop at an attained age
Indicates if automatic inflation protection stops at an attained If field 34 = NIP or there is no limit on inflation protection, this
age of the insured.
field may be zero-filled

3

Attained age of insured when automatic inflation protection
ends.

Numeric value in years
If field 34 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protections end at an attained
age for the policy/certificate.

1=Yes, inflation protection stops at an attained age of the
Policy/Certificate
0=No, inflation protection does not stop at an attained age of
the Policy/Certificate
If field 34 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Attained age of policy/certificate when automatic inflation
protection ends.

Numeric value in years
If field 34 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

Indicates if automatic inflation projection continues for the
entire duration of the policy/certificate.

1=Yes, inflation protection continues for entire duration of the
policy/certificate
0=No, inflation protection does not continue for the entire
duration of the policy/certificate

1

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Inflation Protection Duration Type: When
41 Benefit has Doubled

Inflation Protection Duration Type: Other
42 Trigger Type

43 Future Purchase Option

44 Frequency of Future Purchase Option

45 Termination of FPO Option

46 Policy Status at End of Reporting Period

47 Partnership Status

48 Qualifying Condition
Benefit Start Date of the Current Claim
49 Period

Field
Type

N

N

A

N

AN

A

A

A

N

Field
Field Definition
Length

Field Values

1

Indicates if automatic inflation protection ends when the
benefit has doubled.

1 = Yes
0 = No
If field 34 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

1

Indicates if automatic inflation protection ends by some
trigger other than the triggers described in fields 36, 38, or
41.

1 = Yes, inflation protection ends by some other trigger
0 = No, inflation protection does not end by a trigger
If field 34 = NIP or there is no limit on inflation protection, this
field may be zero-filled.

2

Indicates if the insured has elected or automatically has a
Future Purchase Option (FPO) as a provision of their policy
or certificate and the type of FPO structure.

YA = Annual FPO
YV = FPO, but not Annual
NO = No FPO

3

1 = Annual FPO
Other numeric value for non-annual FPO offers
Indicates the frequency (in years) with which the FPO offer is (e.g. 2 for every 2 years)
made to the insured.
0 = No FPO

2

LT = Offers continue for the life of the policy
D1 = 1 decline triggers termination of offers
D2 = 2 declines trigger termination of offers
C2 = Offers end with 2 consecutive declines
AG = Offers end at specified age
CL = Insured goes into claim
Indicates circumstances, if any, under which Future Purchase OT = Other means of ending the offers
Option ends
NO = No FPO

1

Indicate the status of the PQ policy at the end date of the
current reporting period. Note that values E, V, R, D and O
would only be reported if that status was obtained at some
point during the current reporting period.

I = Inforce
N = Active in non-forfeiture
E = Exhausted benefits
V = Voluntary Lapse
R = Recission
D = Death
T = Not Taken Out (NTO)
O = Other

2

Indicates if the policy remains Partnership Qualified at the
end of the reporting period. NQ should only be reported
once, since persons without PQ policies would be dropped
from File 4 in subsequent reporting periods.

PQ = Partnership Qualified
NQ = No longer qualified for Partnership

1

Indicates whether claimant became eligible for benefits
based on ADL deficits, Cognitive Impairment, Both ADL and
Cognitive Impairments, or some other benefit trigger.

A = ADL Dependency
C = Cognitive Impairment
B = ADL and Cognitive Impairment
O = Other Benefit Eligibility Trigger(s)

8

Indicates date on which benefit payments begin for the
current claim period. This date should occur after any
elimination period has been satisfied.

Format: MMDDYYYY

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er
Nursing Home Benefits Paid During
50 Reporting Period
Home Health Care Benefits Paid During
51 Reporting Period

Field
Type

Field
Field Definition
Length

N

9

Indicates the total amount of benefits for nursing home
services paid during the current reporting period.

Numeric value (in dollars) rounded to the nearest dollar
amount.

9

Indicates the total amount of benefits paid during the
reporting period for home health care and related home
health care services.

Numeric value (in dollars) rounded to the nearest dollar
amount.

N

Field Values

Other Benefit Amounts Paid During
54 Reporting Period

N

9

55 Total Lifetime Benefits Paid to Date

N

9

Indicates the total amount of benefits paid during the
reporting period for assisted living or other non-nursing home Numeric value (in dollars) rounded to the nearest dollar
facility care.
amount.
Indicates the total amount of benefits paid during the
Numeric value (in dollars) rounded to the nearest dollar
reporting period for cash benefits.
amount.
Indicate the total amount of benefits paid during the reporting
period for all benefits paid other than nursing home, home
and community care, assisted living/other facility care, or
Numeric value (in dollars) rounded to the nearest dollar
cash benefits.
amount.
Indicates the total amount of benefits paid under the
Numeric value (in dollars) rounded to the nearest dollar
certificate to date as of the end of the reporting period.
amount.

9

Indicates the total amount of benefits remaining under the
lifetime maximum as of the end of the reporting period.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime benefit expressed in days

9

Indicates the total amount of nursing home benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for nursing home benefits is
expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime benefit expressed in days

9

Indicates the total amount of home health care benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for home health care benefits is
expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime maximum expressed in days
888888888 = No second pool

9

Indicates the total amount of ALF/Other Facility Benefits
benefits remaining in the policy as of the end of the reporting
period, if the lifetime maximum for home health care benefits
is expressed in dollars.

Numeric value (in dollars) rounded to the nearest dollar
amount.
000000000 = Unlimited Lifetime Benefits
999999999 = Lifetime maximum expressed in days
888888888 = No third pool

5

Indicates the total amount of nursing home benefits
remaining for the policy as of the end of the reporting period, Numeric value (in days).
if the lifetime maximum for nursing home benefits is
00000 = Unlimited Lifetime Benefits
expressed in days.
99999 = Pool maximum expressed in dollars

5

Indicates the total amount of home health care benefits
remaining for the policy as of the end of the reporting period,
if the lifetime maximum for home health care benefits is
expressed in days.

Assisted Living/Other Facility Benefits Paid
52 During Reporting Period
N
Total Cash Benefits Paid During Reporting
53 Period
N

56 Remaining Lifetime Benefits

Remaining Lifetime Nursing Home
57 Benefits (Dollars)

Remaining Lifetime Home Health Care
58 Benefits (Dollars)

Remaining Lifetime ALF/Other Facility
59 Benefits (Dollars)

Remaining Lifetime Nursing Home
60 Benefits (Days)

Remaining Lifetime Home Health Care
61 Benefits (Days)

N

N

N

N

N

N

9
9

Numeric value (in days).
00000 = Unlimited Lifetime Benefits
99999 = Pool maximum expressed in dollars
88888 = No second pool

File 4 - Claimant File
For Employer-Paid Core Only & Core & Buy-Up Plans
Field
Numb Field Name
er

Remaining Lifetime ALF/Other Facility
62 Care Benefits (Days)

Field
Type

N

Field
Field Definition
Length

5

Field Values

Indicates the total amount of ALF/Other Facility benefits
Numeric value (in days).
remaining in the policy as of the end of the reporting period, if 00000 = Unlimited Lifetime Benefits
the lifetime maximum for ALF/Other Facility benefits is
99999 = Pool maximum expressed in dollars
expressed in days.
88888 = No third pool