QHP Documents
Templates and DTMs
4/15/2014
Overview of QHP PRA Template Changes
Ver# |
Template Name |
Description |
Changes |
Filename |
V4.0 |
Administrative Data Template |
The Administrative Data Template collects general corporate, marketing, contact and administrative information about the issuer. |
Template has been updated to 2015 version. |
PM.QHP.Administrative Data Template.TMPL.v4.0.04152014.xls |
V4.0 |
URAC Issuer Template |
The URAC Template collects URAC application information to determine and validate market level accreditation status. |
Template has been updated to 2015 version. |
PM.QHP.URAC Issuer Template.TMPL.v4.0.04152014.xls |
V4.0 |
NCQA Issuer Template |
The NCQA Template collects NCQA application information to determine and validate product level accreditation status. |
Template has been updated to 2015 version. |
PM.QHP.NCQA Issuer Template.TMPL.v4.0.04152014.xls |
V4.0 |
Essential Community Providers |
The ECP Template collects provider and street address information about the Essential Community providers in issuer networks. |
Template has been updated to 2015 version. |
PM.QHP.Essential Community Providers.TMPL.v4.0.04152014.xls |
V4.0 |
Plan & Benefits Template and Add-in File |
The Plan & Benefits Template and Add-in file collects high level plan information, benefits package information including benefits covered and treatment limits, cost sharing information and calculates the Actuarial Value. |
Template has been updated to 2015 version, including text changes to assist issuers in its completion. |
PM.QHP.Plan and Benefits Template.TMPL.v4.0.04152014.xlsm PM.QHP.Plan and Benefits Template AddIn.TMPL.v4.0.04152014.xlam
|
V4.0 |
Prescription Drug Template |
The Prescription Drug Template collects formulary information and prescription drug list details. Formularies are associated with plans defined on the Plan & Benefits template for offer on the Exchange with the health plans. |
Template has been updated to 2015 version. |
PM.QHP.Prescription Drug Template.TMPL.v4.0.04152014.xls |
V4.0 |
Network Template |
The Network Template collects information about the provider network name and URL for display during the consumer shopping experience. |
Template has been updated to 2015 version. |
PM.QHP.Network Template.TMPL.v4.0.04152014.xls |
V4.0 |
Service Area Template |
The Service Area Template allows issuers to identify Service Areas by county and zip code. The Service Areas are used in combination with the Rating Engine when determining plan availability and rates. |
Template has been updated to 2015 version. |
PM.QHP.Service Area Template.TMPL.v4.0.04152014.xls |
V4.0 |
Rate Data Template |
The Rating Data Template collects the rate data for each plan and rating area to be offered on the Exchange. |
Template has been updated to 2015 version, including code modification for Tobacco Validation |
PM.QHP.Rate Data Template.TMPL.v4.0.04152014.xls |
V4.0 |
Rating Business Rules Template |
The Rating Business Rules Template collects issuer specific business rules used to calculate rates based on various factors. |
Template has been updated to 2015 version. |
PM.QHP.Rating Business Rules Template.TMPL.v4.0.04152014.xls |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ali Zaher |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |