Form CMS-10371 Operational Metric – SBM Open Enrollment Weekly Indicato

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services

SBM Open Enrollment Weekly Indicators: Layout for State's Data Submission
This document is a suggested submission format for states with state based marketplaces to submit data to the federal government. This format does not
require the submission of individual-level, granular data. The data will be used to assess the Marketplace progress in operational performance, QHP plan
premiums and subsidies, and enrollment/eligibility activity for initial years of operations.
QHP Data in this layout are specific to medical QHPs (not dental or vision) and coverage offered through the marketplaces (not Medicaid or CHIP
coverage). The one exception is the SHOP-specific data elements which specify if the coverage is medical or dental.
If no data match the restrictions of a particular data element, enter "0" (zero). If the data are believed to be reportable in the future, but are not
reportable at the time that the data are submitted, enter "-888" to indicate the data are not available. If it is not possible to report a data element
because of the way the marketplace is operated, enter "-999" to indicate the data elements are not applicable.
Reporting Schedule: Weekly during Open Enrollment; aggregated to 4 weeks of data during other parts of the year. The first scheduled reporting date is
October 5, 2013. Additional information about submission of test data and final data will be distributed separately at a later date. Questions should be
directed to Christina Daw at [email protected].

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0938-XXXX. The time required to complete this information collection is
estimated to average [Insert Time (hours or minutes)] per response, including the time to review instructions, search existing data resources, gather the
data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions
for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850. Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports
Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control
number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents,
please contact 1-800-MEDICARE.

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Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services

Glossary of Data Breakout Terms for Weekly and other Marketplace Metrics Reported by States
Age

Age of individual as of most recent effective enrollment date:
<18 years
18-25
26-34
35-44
45-54
55-64
≥65

Application
Assistance

Describes whether individuals received assistance with either submission of application for QHP enrollment or with
selection of a QHP.
1) Any (i.e. at least one type of the assistors list below)
2) None (i.e., no recorded assistance)

FPL

FPL (Federal Poverty Level) is calculated based on the projected, total, annual modified adjusted gross income (MAGI) for
the taxpayer’s family. FPL is based on the same MAGI as the SBM uses to determine eligibility of APTC.
- MAGI includes the sum of the income of the taxpayer and the lawfully present individuals for whom the taxpayer
properly claims a deduction for personal exemption for the taxable year. For additional information see Health Insurance
Premium Tax Credit, 77 Fed. Reg. 30377 (amending 26 CFR pts. 1 and 602). May 23, 2012.
(http://www.gpo.gov/fdsys/pkg/FR-2012-05-23/pdf/2012-12421.pdf).
- To report FPL, MAGI should be compared to the HHS poverty guidelines (current levels found here
http://aspe.hhs.gov/poverty/13poverty.cfm), which is adjusted for the size of the family and state of residence.
- For the purposes of the SBM Supplemental Data Submission, MAGI may or may not be verified. States should report FPL
based on incomes as of the most recent eligibility determination.
- For individuals that do not request an eligibility determination for financial assistance, MAGI may not be available. If
MAGI is unavailable, populate the cell for the number of people with unknown FPL and enter -888 for each FPL category
to signal data unavailable. Entering zero would signify no individuals at that income level.
The breakouts of FPL based on annual household income are:
1) <100%

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Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
2) ≥100 - ≤138%
3) >138 - ≤150%
4) >150 - ≤200%
5) >200 - ≤250%
6) >250 - ≤300%
7) >300- ≤400%
8) >400%
9) unknown
Metal Tier
Metal tier associated with a health plan:
Catastrophic
Bronze
Silver
Gold
Platinum
# Enrollment
Number of enrollment assisters who completed Marketplace training during the reference period.
Assisters
completing
Marketplace
training
# Enrollment
Assisters
registered and
certified

Number of enrollment assisters who were registered and certified during the reference period.

Total call volume

Number of calls that entered the integrated voice response system during the reference period.

Average call wait
time
(Average speed
of answer- ASA)

Average length of time for which a call is connected to automated call distribution system before answered (average time
a caller waits in queue before being connected to an agent) during the reference period. Average is for the reporting
time period. Quarterly reporting is a Quarterly average. Reported in timestamp format (mm:ss).

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Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Average call
Average amount of time an agent spends on call. Average is for the reporting time period. Quarterly reporting is a
handle time
Quarterly average. Reported in timestamp format (mm:ss).
(AHT)
Abandonment
Rate

Count of total number of calls abandoned (numerator)in the queue (Calls that terminate or drop before reaching an
agent or being answered) divided by total call volume (denominator).

Total website
page views

Count of page views across the whole Marketplace site during the reference period.

Total website
visits

Count of unique visits to the marketplace website during the reference period.

Total website
unique visitors

Count of unique visitors to the marketplace website during the reference period.

# of registered
users

Count of secure accounts established (registered users) during the reference period.

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Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Initial Applications
– Application Level

Determined eligible

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Indicator for Cell

Number of Electronic Applications Initiated

Init Appl: Total

Number of Applications Completed, by Electronic and Paper

Compl Appl: Electronic
Compl Appl: Paper
Compl Appl: Total
Individuals Appl: Total

Number of Individuals Applying for Coverage through the
Marketplace (Individual level)
Number of Registered User Accounts Established/Created
Number of Individuals Determined Eligible for Enrollment into
a QHP

Registered Accounts: Total
Eligible: Total
Eligible without FA
Eligible with FA: APTC Only: FPL 1
Eligible with FA: APTC Only: FPL 2
Eligible with FA: APTC Only: FPL 3
Eligible with FA: APTC Only: FPL 4
Eligible with FA: APTC Only: FPL 5
Eligible with FA: APTC Only: FPL 6
Eligible with FA: APTC Only: FPL 7
Eligible with FA: APTC Only: FPL 8
Eligible with FA: Total
Eligible with FA: APTCs+CSRs: FPL1
Eligible with FA: APTCs+CSRs: FPL2
Eligible with FA: APTCs+CSRs: FPL3
Eligible with FA: APTCs+CSRs: FPL4
Eligible with FA: APTCs+CSRs: FPL5
Eligible with FA: APTCs+CSRs: FPL6
Eligible with FA: APTCs+CSRs: FPL7

Format
Numeric
unless
otherwise
indicated

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Distribution of Eligibility Assessments (by number of
assessments) by Insurance Affordability Program (Integrated
Systems) If able to break out by IAP

Enrollment Activity

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(Non-integrated system): Number of accounts transferred to
Medicaid
(Non-integrated system): Number of accounts transferred to
CHIP
(Non-integrated system): Number of accounts transferred to
Medicaid or CHIP
Number of Individuals enrolled in QHP (whether or not
effectuated)
Number of Individuals with Enrollment by APTCs only, and
APTCs and CSRs, by FPL

Indicator for Cell

Eligible with FA: APTCs+CSRs: FPL8
Eligible with FA: APTCs+CSRs: FPL9
Eligible with FA: Total
Eligib assessment: Medicaid
Eligib assessment: CHIP
Eligib assessment: Medicaid + CHIP
Eligib assessment: QHP
Accounts trans: Medicaid
Accounts trans: CHIP
Accounts trans: Medicaid+CHIP
Individuals Enrolled: Total
Enrolled without FA: Total
Enrolled with FA: APTC Only: FPL 1
Enrolled with FA: APTC Only: FPL 2
Enrolled with FA: APTC Only: FPL 3
Enrolled with FA: APTC Only: FPL 4
Enrolled with FA: APTC Only: FPL 5
Enrolled with FA: APTC Only: FPL 6
Enrolled with FA: APTC Only: FPL 7
Enrolled with FA: APTC Only: FPL 8
Total Enrolled with FA: APTC only
Enrolled with FA: APTCs+CSRs: FPL1

Format
Numeric
unless
otherwise
indicated

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Number of Individual Market Enrollments by Age Group

Number of Individual Market Enrollments by FPL

Number of Individual Market QHP Enrollment by Metal Level

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Indicator for Cell

Enrolled with FA: APTCs+CSRs: FPL2
Enrolled with FA: APTCs+CSRs: FPL3
Enrolled with FA: APTCs+CSRs: FPL4
Enrolled with FA: APTCs+CSRs: FPL5
Enrolled with FA: APTCs+CSRs: FPL6
Enrolled with FA: APTCs+CSRs: FPL7
Enrolled with FA: APTCs+CSRs: FPL8
Enrolled with FA: APTCs+CSRs: FPL9
Total Enrolled with FA: APTCs+CSRs
Enrolled by Age: AGE1<18
Enrolled by Age: AGE2 18-25
Enrolled by Age: AGE3 26-34
Enrolled by Age: AGE4 35-44
Enrolled by Age: AGE5 45-54
Enrolled by Age: AGE6 55-64
Enrolled by Age: AGE7 ≥65
Enrolled by FPL: FPL1
Enrolled by FPL: FPL2
Enrolled by FPL: FPL3
Enrolled by FPL: FPL4
Enrolled by FPL: FPL5
Enrolled by FPL: FPL6
Enrolled by FPL: FPL7
Enrolled by FPL: FPL8
Enrolled by Level: Catastrophic
Enrolled by Level: Bronze
Enrolled by Level: Silver
Enrolled by Level: Gold
Enrolled by Level: Platinum

Format
Numeric
unless
otherwise
indicated

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Number of Individual Market QHP Enrollment by Issuer (Top 3)

Median Individual Premium by Age Group within Metal Level

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Indicator for Cell

Enrolled by Issuer: Issuer 1
Enrolled by Issuer: Issuer 2
Enrolled by Issuer: Issuer 3
Name Issuer 1
Name Issuer 2
Name Issuer 3
Median Indiv Age Level: Catastrophic: 18-25
Median Indiv Age Level: Catastrophic: 26-34
Median Individ Age Level: Bronze: AGE1
Median Individ Age Level: Bronze: AGE2
Median Individ Age Level: Bronze: AGE3
Median Individ Age Level: Bronze: AGE4
Median Individ Age Level: Bronze: AGE5
Median Individ Age Level: Bronze: AGE6
Median Individ Age Level: Bronze: AGE7
Median Individ Age Silver: AGE1
Median Individ Age Silver: AGE2
Median Individ Age Silver: AGE3
Median Individ Age Silver: AGE4
Median Individ Age Silver: AGE5
Median Individ Age Silver: AGE6
Median Individ Age Silver: AGE7
Median Individ Age Gold: AGE1
Median Individ Age Gold: AGE2
Median Individ Age Gold: AGE3
Median Individ Age Gold: AGE4
Median Individ Age Gold: AGE5
Median Individ Age Gold: AGE6
Median Individ Age Gold: AGE7

Format
Numeric
unless
otherwise
indicated

Text
Text
Text

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Median Individual Premium with APTC
Median Individual Premium without APTC
Average Individual Premium with APTC
Average Individual Premium without APTC
Average Individual Premium with APTC by Metal Level

Average Individual Premium without APTC by Metal Level

Average APTC payment selected, by tax household
Number of enrollments using Assistance (at application level)
Effectuated
Enrollment

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Number of Individuals with Effectuated Enrollment in QHP
Number of Individuals with Effectuated Enrollment with APTCs
only, and APTCs and CSRs, by FPL

Indicator for Cell

Median Individ Age: Platinum:AGE1
Median Individ Age: Platinum:AGE2
Median Individ Age: Platinum:AGE3
Median Individ Age: Platinum:AGE4
Median Individ Age: Platinum:AGE5
Median Individ Age: Platinum:AGE6
Median Individ Age: Platinum:AGE7
Median Indiv Premium: APTC
Median individ Premium: No APTC
Ave Indiv Premium: APTC
Ave Indiv premium: No APTC
Ave Individ Premium: APTC: Catastrophic
Ave Individ Premium:APTC: Bronze
Ave Individ Premium: APTC: Silver
Ave Individ Premium: APTC: Gold
Ave Individ Premium: APTC: Platinum
Ave Individ Premium: No APTC:Catastrophic
Ave Individ Premium: No APTC:Bronze
Ave Individ Premium: No APTC:Silver
Ave Individ Premium: No APTC:Gold
Ave Individ Premium: No APTC:Platinum
Ave APTC Selected
Enrollment Using Assistance: Yes
Enrollment Using Assistance: No
Individ Effect:Total
Effectuated with FA: APTC Only: FPL 1
Effectuated with FA: APTC Only: FPL 2

Format
Numeric
unless
otherwise
indicated

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

SHOP

Operations
10

Effectuated Enrollment: Average APTC payment
Number of Employers Applied to SHOP
Number of SHOP Participating Employers (Effectuated
Enrollment)
Average Number of SHOP Employees per Participating
Employer (Effectuated Enrollment)
Average Employer Premium Contribution Percent (Effectuated
Enrollment)
Number of Employees Covered Through SHOP (Effectuated
Enrollment): Total in State
Call Center Volume
Call Center Wait Time (mm:ss)

Indicator for Cell

Effectuated with FA: APTC Only: FPL 3
Effectuated with FA: APTC Only: FPL 4
Effectuated with FA: APTC Only: FPL 5
Effectuated with FA: APTC Only: FPL 6
Effectuated with FA: APTC Only: FPL 7
Effectuated with FA: APTC Only: FPL 8
Effectuated with FA: APTC only: Total
Effectuated with FA: APTCs+CSRs: FPL1
Effectuated with FA: APTCs+CSRs: FPL2
Effectuated with FA: APTCs+CSRs: FPL3
Effectuated with FA: APTCs+CSRs: FPL4
Effectuated with FA: APTCs+CSRs: FPL5
Effectuated with FA: APTCs+CSRs: FPL6
Effectuated with FA: APTCs+CSRs: FPL7
Effectuated with FA: APTCs+CSRs: FPL8
Effectuated with FA: APTCs+CSRs: FPL9
Effectuated with FA: APTCs+CSRs:Total
Effectuated Average APTC payment
SHOP: Employers Appl: Total
SHOP: Employers Effect: Total
SHOP: Ave Enrolled Employees in Empl Gr:
Total
SHOP: Ave Percent Empl Contrib
SHOP: Enrolled Employees: Total
Call Ctr: Total Calls
Call Ctr: Ave Wait Time

Format
Numeric
unless
otherwise
indicated

Center for Consumer Information & Insurance Oversight
Centers for Medicare & Medicaid Services
Department of Health & Human Services
Category

Call Center Abandonment Rate
Average Call Handle Time
Number of Mail/Written Correspondence Received
Number of Website Visits
Number of Website Unique Visitors
Number of Website Page Views
Number of Trained/Certified Assistors
Website Time Offline (mm:ss)

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Indicator for Cell

Call Ctr: Aband Rate
Call Ctr: Ave Handle Time
Written+Fax: Total
Website: Visits: Total
Website: Visitors: Total
Website: Views:Total
Train+Cert Assist: Total
Website Offline: Total Time

Format
Numeric
unless
otherwise
indicated