CMS-10433 Rate Table Template

Rates Table Template
To validate press Validate button or Ctrl + Shift + V. To finalize, press Finalize button or Ctrl + Shift + F.
If you are a community rating state, select Family Option under Age and fill in all columns.
If you are not community rating state, select 0-20 under Age and provide an Individual Rate for every age band.
If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use.
To add a new sheet, press the Add Sheet button, or Ctrl + Shift + S. All plans must have the same dates on a sheet.
HIOS Issuer ID*
Federal TIN*
Rate Effective Date*
Rate Expiration Date*
Plan ID* Required: Enter the 14-character Plan ID	Rating Area ID* Required: Select the Rating Area ID	Tobacco* Required: Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan	Age* Required: Select the age of a subscriber eligible for the rate	Individual Rate* Required: Enter the rate of an Individual Non-Tobacco or No Preference enrollee on a plan	Family Tier - Couple * Required: Enter the rate of a couple based on the pairing of a primary enrollee and a secondary subscriber (e.g. husband and spouse)	Family Tier - Primary Subscriber and One Dependent* Required: Enter rate of a family based on a single parent with one dependent	Family Tier - Primary Subscriber and Two Dependents* Required: Enter the rate of a family based on a single parent with two dependents	Family Tier - Primary Subscriber and Three or More Dependents* Required: Enter the rate of a family based on a single parent with three or more dependents	Family Tier - Couple and One Dependent* Required: Enter the rate of a family based on a couple with one dependent	Family Tier - Couple and Two Dependents* Required: Enter the rate of a family based on a couple with two dependents	Family Tier - Couple and Three or More Dependents* Required: Enter the rate of a family based on a couple with three or more dependents