| Data Element |
Mandatory Y/N |
Definition |
| State Abbreviation |
Yes |
The two digit State abbreviation as recognized by the US Postal Service |
| Reviewed by State Y/N |
Yes |
A yes/no flag used to identify whether the rate change was reviewed by the State. This value will be "no" for States that collect information but do not currently review rates and for States that "deem" rates approved. |
| State Review Includes Actuary Y/N |
Yes - if Reviewed by State is yes, otherwise, No |
A yes/no flag that demonstrates if the State review process includes a review by an actuary. |
| Insurance Company Name |
Yes |
The name of the insurance company |
| Insurance Product Name |
Yes |
The name of the insurance product as sold by the insurance company |
| Issuer ID |
Yes |
The unique identifier as assigned by the HHS HIOS system. |
| Policy Form ID |
Yes |
The policy form ID of the insurance product as sold by the insurance company (NAIC policy or other ID) |
| Rate Filing ID |
Yes |
The rate filing ID of the insurance product as sold by the insurance company (NAIC policy or other ID) |
| New Policy Y/N |
Yes |
A yes/no flag that demonstrates if the policy is a New issue that has never been issued before. |
| Market Segment |
Yes |
Allowable values for market segment are: Large group, Small group, Individual, Conversion |
| Comprehensive Medical Coverage Type |
Yes |
Allowable values for comprehensive medical coverage type are: HMO, PPO, POS, FFS, EPO, Other - (please note details) |
| Block Status |
Yes |
Demonstrates if the rate for the policy is "open", "closed" |
| Rate Effective Date |
Yes |
Date that the rate is effective for the policyholders. |
| % Change Requested |
Yes |
The percentage of change approved can be a positive or negative number. |
| % Change Approved |
No |
The percentage of change requested can be a positive or negative number. |
| Change Period |
Yes |
Demonstrates the time for which the premium change is effective. Allowable values are: Annual, Semi-annual, Quarterly, Other - (Please note details) |
| Number Affected Insured's |
Yes - unless Number Affected Policy Holders is the only data collected by the State |
Total number of enrolled individuals affected by the rate change. This may be null for States that only collect policy holder counts. |
| Number Affected Policy Holders |
Yes - unless Number Affected Insured's is the only data collected by the State |
Total number of policy holders affected by the rate change. This may be null for States that only collect the number of enrolled individuals. |
| Member Months |
Yes |
The member months used for the purpose of the rate development. |
| Annual $ for New Rate |
Yes |
The dollar amount of the New Annual Rate. |
| Annual $ for Prior Rate |
Yes |
The dollar amount of the Prior Annual Rate. |
| SERFF Tracking Number |
No |
The tracking number assigned by the NAIC SERFF system assigned to the rate filing? |
| SERFF Rate Filing Type |
No |
The rate filing type as used in the NAIC SERFF system. |
| NAIC Company ID Number |
No |
The company identifier assigned by the NAIC system to identify the insurer. |
| Description of trend factors |
No |
Text description of trend factors and rating factors used in developing the rate |
| Benefit Adjusted Y/N |
Yes |
A yes/no flag used to identify if the benefits were adjusted or changed for the period. |
| Deductible Increase Y/N |
Yes |
A yes/no flag used to identify if the deductible amount was increased. |
| Benefit Increase Y/N |
Yes |
A yes/no flag used to identify if the services bevefits were increased. |
| Benefit Decrease Y/N |
Yes |
A yes/no flag used to identify if the services bevefits were decreased. |
| Cost Sharing Y/N |
Yes |
A yes/no flag used to identify if there are cost sharing requirements for the rate. |
| Coinsurance Y/N |
Yes |
A yes/no flag used to identify if there are coinsurance requirements for the rate. |
| Primary Care Copayment Amount |
Yes |
The copayment required at the primary care doctors office that coincides with the rate |
| Specialist Care Copayment Amount |
Yes |
The copayment required at specialty care doctors office that coincides with the rate |
| Inpatient Hospital Copayment Amount |
Yes |
The copayment required for inpatient hospitalization that coincides with the rate |
| Outpatient Hospital Copayment Amount |
Yes |
The copayment required for outpatient hospitalization that coincides with the rate |
| Generic Pharmacy Copayment Amount |
Yes |
The copayment required for generic drugs at the pharmacy that coincides with the rate |
| Brand Pharmacy Copayment Amount |
Yes |
The copayment required for brand name drugs at the pharmacy that coincides with the rate |
| Total Earned Premium Amount - Prior year |
Yes |
The total dollar amount collected for the purpose of premium payments. |
| Total Incurred Claims Amount - Prior year |
Yes |
The total dollar amount paid for services incurred. |
| Disposition of Rate Review |
No |
The disposition of the rate review, e.g. "approved," denied", "deferred", |
| Prospective Rate % Attributed to Claims and Capitation |
Yes |
The prospective percent of the rate increase attibuted to historical Claims and Capitation |
| Prospective Rate % Attributed to Admin |
Yes |
The prospective percent of the rate increase attibuted to historical Admin increase |
| Prospective Rate % Attributed to Broker Commissions |
Yes |
The prospective percent of the rate increase attibuted to historical Claims and Capitation increase |
| Prospective Rate % Attributed to Premium Taxes |
Yes |
The prospective percent of the rate increase attibuted to historical Premium tax increase |
| Prospective Rate % Attributed to Assessment Fees |
Yes |
The prospective percent of the rate increase attibuted to historical assessment fee increase |
| Prospective Rate % Attributed to Federal Taxes |
Yes |
The prospective percent of the rate increase attibuted to historical Federal tax increase |
| Prospective Rate % Attributed to Reserves |
Yes |
The prospective percent of the rate increase attibuted to historical reserves increase |
| Medical Price % Change |
Yes |
The medical price percentage of change used to develop the rate |
| Medical Utilization % Change |
Yes |
The medical utilization percentage of change used to develop the rate |
| Medical Trend % Insufficient Prior Rate |
Yes |
The percentage of historical insufficient prior rate used as a factor to develop the current rate |
| Overall Medical Trend % Increase |
Yes |
Derived data - The prospective total of the Medical Price % Change, Medical Utilization % Change, and the Medical Trend % Insufficient Prior Rate |