CMs-10433 Business Rules Template

Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations (CMS-10433)

AppH_NONFUNCTIONAL_RatingBusinessRules.xls

QHP Certification

OMB: 0938-1187

Document [xlsx]
Download: xlsx | pdf


All fields with an asterisk (*) are required. To validate the template, press Validate button or Ctrl + Shift + I. To finalize the template, press Finalize button or Ctrl + Shift + F.








If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells C1 through C4.
Enter the Issuer Rule on the first row (no Product ID or Plan ID).










For each Product rule, enter only the Product ID and the business rules that differ from the Issuer Rule.










For each Plan rule, enter only the Plan ID and the business rules that differ from the Product or Issuer Rule






























HIOS Issuer ID*










TIN*










Product ID Plan ID
(Standard Component)
How are rates for contracts covering two or more enrollees calculated? What are the maximum number of under age (under 21) dependents used to quote a two parent family? What are the maximum number of under age (under 21) dependents used to quote a single parent family? Is there a maximum age for a dependent? What are the maximum number of children used to quote a children-only contract? Are domestic partners treated the same as secondary subscribers? Are same-sex partners treated the same as secondary subscribers? How is age determined for rating and eligibility purposes? How is tobacco status determined for subscribers and dependents? What relationships between primary and dependent are allowed, and is the dependent required to live in the same household as the primary subscriber?













File Typeapplication/vnd.ms-excel
File TitleBusiness Rules Template
SubjectRates Business Rules
AuthorCMS
Last Modified ByO'Brien, Tayseer
File Modified2019-01-28
File Created2012-02-01

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