Form CMS-10320 State Instructions and Instrument

CMS Form Number: CMS-10320
OMB Control Number: 0938-1086
Expiration Date: XX/20XX

Health Insurance Oversight System (HIOS) Excel
Data Submission Tool - States
Technical Instructions

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 0938-1086. The time required to complete this information collection is
estimated to average ( 10.17 hours) or (609.6 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.

Last updated May 5, 2010

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions

Table of Contents
1

Introduction ........................................................................................................................2

2

State Data Entry Form Functions .......................................................................................3
2.1

Submission Requirements ............................................................................................3

2.2

How to Open the State Form Workbook .......................................................................3

2.3

Circle Invalid .................................................................................................................6

2.4

Finalizing the State Data Entry Form for Submission ....................................................8

2.5

Closing the file ..............................................................................................................9

2.6

Password Protection .....................................................................................................9

3

Tips for Entering Data ......................................................................................................10
3.1

State General Info Tab ...............................................................................................10

3.2

State Issuer & Product Info Tab ..................................................................................13

4

Troubleshooting and FAQ ................................................................................................17
4.1

FAQ’s .........................................................................................................................17

4.2

Submission Information ..............................................................................................17

4.3

Support .......................................................................................................................17

5

Appendix A— Critical Errors .............................................................................................18
5.1

6

State Data Critical Errors and Related Error Messages ..............................................18
Appendix B—Required Fields...........................................................................................20

1

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
1

Introduction

The Health Insurance Oversight System (HIOS) will allow the government to collect data from
states and individual and small group market issuers, which will be aggregated with other data
sources and made public on a consumer facing website. One initial mechanism for the states to
submit their data is through the use of the HIOS Excel template.
These technical instructions explain the special features and other technical aspects related to the
use of the HIOS State Data Submission Excel Tool. The State Data Submission Excel Tool
consists of two worksheets that must be completed prior to submission:
•

State General Info: Supports the data entry for the state’s general information, primary
and validation contacts.

•

State Issuer & Product Info: Supports the data entry for a listing of issuers with offerings
in the corresponding state, along with contact and product information for each issuer.

The Office of Consumer Information & Insurance Oversight (OCIIO), a division of HHS,
recommends that users read this document thoroughly before using the tool.
The State Data Submission Tool employs two versions of the workbook that serve different
purposes throughout the process:
•

Working files – are read-write enabled files that allow users to enter data in specified
input fields. Users may edit, save, name, and re-name working versions of these files.

•

Finalized files – are read-only files created by a process called finalization, which
modifies the format of working files to prepare them for submission to HHS. Finalization
converts formula results in calculated fields into hard-coded values, removes formulas
and other extraneous elements, and saves the file using a standard naming convention.
All macro file functionalities are disabled. The finalized save process will delete or
standardize some of the data in the finalized file according to specified business rules.
The finalized save process will not change the data in the working file. (See Section
2.4.1.)

2

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
2
State Data Entry Form Functions
2.1

Submission Requirements

2.1.1

Initial Configuration Requirement

For the State Data Entry Form to work properly, you must configure your PC to satisfy the
following requirements:
•

Have Microsoft Excel 2003 or greater installed.

•

Enable your Excel Standard Toolbar.

•

For Excel 2003, set your Excel Macro Security Settings to Medium (recommended). You
can do this by selecting Tools, Macro, and the Security command from your Excel menu
bar. *

•

For Excel 2007, set your Excel Macro Security Settings to “Disable all macros with
notifications.” You can do this by selecting the Office Button, Excel Options, Trust
Center, Trust Center Settings, Macro Settings. *

* Macros from un-trusted sources could potentially contain malicious code. If your macro
settings are configured as stated above, you will be able to select which macros are safe and
therefore should be enabled. The following section details how to enable these macros so that
you can successfully use the State Form.
2.2
2.2.1

How to Open the State Form Workbook
Macro Security Level Setting

For Excel 2003
The State Data Entry form uses macros to perform the built-in functions including the validation
and finalization processes.
If your Macro Security setting is set to Medium (as recommended above), you will be prompted
to enable or disable macros when you open the workbook. You must choose “Enable macros” to
correctly open the form. If you choose “Disable macros,” the workbook will display a screen
stating that the macros must be enabled in order to use the form. You will have to close and then
reopen the workbook to enable macros.
If your macro settings are set to High or Very High, the workbook will not be functional. A static
screen will display indicating that you must update your macro settings.
For Excel 2007
The State Data Entry form is supported in Excel 2007. You will be able to open and work with
the HIOS files using Excel 2007’s compatibility mode. However, you MUST save and/or

3

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
finalize the HIOS files in the Excel 2003 (.xls) format once you are finished. You will only be
able to submit an “.xls” HIOS file.
If you try to save in Excel 2007 (.xlsx) you will get the following error. If you select yes it will
make the workbook inoperable.

Note: If a HIOS file is saved in the Excel 2007 (.xlsm) format, an error will occur when you
attempt to reopen the file. Please do not save the HIOS file in .xlsm format. This applies to
working files as well.
If your Macro Security setting is set to “Disable all macros with notification” (as recommended
above), the workbook will open and you will see the following message above the worksheet:
“Security Warnings. Macros have been disabled.” – followed by an ‘Options...’ button (as seen
in the screen shot below). You must click the ‘Options…’ button and select “Enable this
content” to continue working with the file.

4

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions

If the current security setting is set to “Disable all macros except digitally signed macros” or
“Disable all macros without notifications”, the workbook will not be functional (i.e. you will not
be able to validate and finalize).
You will be able to open and work with multiple State Data Entry Forms in the same Excel 2007
instance. But if you want to close a file and open another one, you should also close Excel and
open the next file in a new instance of Excel. There are known issues related to Excel 2007
when you open a file in an existing Excel instance. If you encounter any issues when opening a
State Data Entry form, then close Excel, go to Task Manager, delete any other Excel processes,
then open a new State Data Entry file in a new Excel window.
Note: After completion of the workbook it is suggested that if you had to change your default
macro settings for this workbook that you change them back to your original macro settings.
2.2.2

Commands

Upon successfully opening a working State Data Entry Form with the macros enabled, specific
buttons will appear in each worksheet.
Button names (from left to right):

5

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
•

Validate (Shortcut: CTRL + shift + V) – this will perform the red circle and critical
validations.

•

Validate and Finalize (Shortcut: CTRL + shift + S) - this function will perform the
critical validations and create the read-only finalized file.

•

Format and Print Preview (Shortcut: CTRL + shift + P) – this function will format the
workbook for printing and bring to focus the print preview screen for the user.

2.2.3

Validations

All data entry fields are highlighted in green. All cells are formatted in Text format.
It is recommended that you not use Excel’s “Cut” function in the State Data Entry Form
workbook as it will remove the cell’s predefined formatting.
Note: You should use the Delete key instead of the Space bar to delete cell values from a cell.
2.2.4

Critical Validations

The green-highlighted data entry fields fall into three categories with respect to cell validation:
validation fields, critical validation fields, and non-validation fields. Validation fields have cellspecific rules regarding the types and format of data that can be entered into them. These rules
appear in message boxes called cell labels which are shown when the cell is highlighted.
2.3

Circle Invalid

Upon opening the worksheet, red circles will surround cells that do not pass specific validation
rules. Once the data has been entered and has passed the validation rules, the red circles will
disappear.
It is strongly recommended that you correct all red circle validations prior to finalizing your
workbook. Not all red circle validations are checked in the finalization process thus it is possible
that you finalize your file with data errors. These data errors will be caught when the file is being
processed and will be returned to you for correction.
It is highly recommended that you use the “Validate” function prior to the “Validate and
Finalize” function. You should only trigger the “Validate and Finalize” if no red circle
validations have failed.
Note: If you enter invalid information into a cell with validation rules and attempt to exit the cell,
you will receive the error below. Please click the ‘Cancel’ button to continue working and
enter/select a valid value for the cell.

6

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions

2.3.1

Printing the file

You have two options for printing the State Data Entry form. You may use the standard excel
Print function to print or you may click on the Format & Print Preview button within each
worksheet.
2.3.2

Save Functions

There are two save processes available within the State data Entry form: a non-finalized and a
finalized save.
A non-finalized save can be invoked by clicking on the Excel Save icon on the Excel Standard
Toolbar or by selecting File and then Save from the Excel menu. This save process will save any
changes you have made to the workbook.
A finalized save occurs when the “Finalize and Validate” function is invoked. (See Section 2.4,
“Finalizing the State Data Entry Form for Submission.”) This step is taken when the workbook
is complete and ready for submission.
Note: after clicking “Save” or “Finalize & Validate Form,” the following message may appear:

7

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions

Uncheck the box “Check compatibility when saving this workbook” and click “Continue.” The
popup will not appear next time you save a form.
2.4

Finalizing the State Data Entry Form for Submission

To trigger the finalization process, click on the Validate & Finalize File button. The system will
perform all of the critical validations. The system will perform the finalization process and create
the read only file if all critical validations are passed.
As stated in Section 2.3, it is highly recommended that you correct all red circle validations
prior to triggering the finalization process.
2.4.1

Finalization Process

When the finalization function is triggered, the system will perform the following actions:
•

Check the required fields— Pre-determined fields (e.g., “State”) must be entered for the
finalization to be successful; these fields are listed in Appendix B (“Required Fields”).

•

Check the critical validations—Critical validation fields must comply with their
validation rules for the finalization process to be successful; the fields and business rules
are listed in Appendix A (“Critical Validation Fields”). All critical errors must be
corrected for a file to be successfully finalized.

•

Create a finalized file with the following features:
ο All worksheets will display as read only in the finalized file.

8

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
ο Red circles will display for cells that do not pass validation rules. Note: You will
be able to finalize the file if the red circled cell is not one of the critical errors. A
list of critical validations for is included in Appendix A, “Critical Errors.”
2.4.2

File Naming Convention

Finalized State Data Entry Submission workbooks are saved using the following standardized
naming convention:
Final__. xls
Use of this naming convention is a requirement for a successful submission. If you modify
the name of the finalized file, it will not be processed.
Example: Final_VA20100427130426_State Data Entry Form.xls
Note: Finalized files will be saved in the same directory where the working file is located.
Note: Original name refers to the name of the working file. There is not a requirement for how
the working file must be named and it will not impact the processing of the finalized file.
The working file name can be changed at any time. The finalized forms are read-only files. If
you need to make additional changes prior to submission, modify the working file and finalize
the file again. Remember that the naming convention mentioned above, which is used for the
finalized file, is required for submission.
2.5

Closing the file

When closing the file it is highly recommended that you save all current changes.
2.6

Password Protection

The State Data Entry form is password protected. You may not modify the structure of the
workbook or worksheets. Each data item must be located in its pre-defined cell location for
successful processing.

9

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
3

Tips for Entering Data

Note: Please verify that all of the Submission Requirements specified in section 2.1 have been
met before continuing with this section.
This section will provide information on how to enter data into each required cell within the
workbook.
3.1

State General Info Tab

The following table includes the cell location for each data entry field on the State General Info
tab along with appropriate values.
Cell Location

Data

E3

State Name

E4

Underwriting Status

E6

Does your state have a
comparison tool for the Small
Group Market?
Website address for
comparative tool or state
address.

E7

E9

E10

D14

Does your state have a
comparison tool for the
Individual Market?
Website address for
comparative tool or state
address.

Primary State Data
Submission Contact First
Name

Valid Valies
Select a value from the drop
down list. Do not type in a state
name.
Select Yes or No from the drop
down. Do not type in a value.
Select Yes or No from the drop
down. Do not type in a value.
If you answered Yes to E6, enter
the full website address for the
comparative tool (e.g.
www.comparative_tool.gov) . If
you answered No to E6, enter
your full state website address
(e.g. www.state.us.gov).
Select Yes or No from the drop
down. Do not type in a value.
If you answered Yes to E9, enter
the full website address for the
comparative tool (e.g.
www.comparative_tool.gov) . If
you answered No to E9, enter
your full state website address
(e.g. www.state.us.gov).
Enter the first name of the
individual who is the primary
contact for the submission of this
data. The system allows up to 40
characters.

10

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
Cell Location
F14

Data
Primary State Data
Submission Contact Last
Name

D15

Primary State Data
Submission Contact Phone
Number

F15

Primary State Data
Submission Contact Phone
Number Extension

D16

Primary State Data
Submission Contact Email
Address

D19

Back Up State Data
Submission Contact First
Name

F19

Back Up Data Submission
Contact Last Name

D20

Back Up Data Submission
Contact Phone Number

Valid Valies
Enter the last name of the
individual who is the primary
contact for the submission of this
data. The system allows up to 40
characters.
Enter the phone number for the
individual who is the primary
contact for the submission of this
data. The system allows up to 15
characters.
Enter the phone number
extension for the individual who
is the primary contact for the
submission of this data. The
system allows up to 15
characters. THIS FIELD IS
OPTIONAL.
Enter the email address for the
individual who is the primary
contact for the submission of this
data. Please make sure to include
the full email address (e.g.
[email protected]). The system will
validate that the @ is part of the
address.
Enter the first name of the
individual who is the back up
contact for the submission of this
data. The system allows up to 40
characters.
Enter the last name of the
individual who is the back up
contact for the submission of this
data. The system allows up to 40
characters.
Enter the phone number for the
individual who is the back up
contact for the submission of this
data. The system allows up to 15
characters.

11

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
Cell Location
F20

Data
Back Up Data Submission
Contact Phone Number
Extension

D21

Back Up State Data
Submission Contact Email
Address

D25

Primary State Data Validation
Contact First Name

F25

Primary State Data Validation
Contact Last Name

D26

Primary State Data Validation
Contact Phone Number

F26

Primary State Data Validation
Contact Phone Number
Extension

Valid Valies
Enter the phone number
extension for the individual who
is the back up contact for the
submission of this data. The
system allows up to 15
characters. THIS FIELD IS
OPTIONAL.
Enter the email address for the
individual who is the back up
contact for the submission of this
data. Please make sure to include
the full email address (e.g.
[email protected]). The system will
validate that the @ is part of the
address.
Enter the first name of the
individual who is the primary
contact for the validation of this
data. The system allows up to 40
characters.
Enter the last name of the
individual who is the primary
contact for the validation of this
data. The system allows up to 40
characters.
Enter the phone number for the
individual who is the primary
contact for the validation of this
data. The system allows up to 15
characters.
Enter the phone number
extension for the individual who
is the primary contact for the
validation of this data. The
system allows up to 15
characters. THIS FIELD IS
OPTIONAL.

12

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
Cell Location
D27

Data
Primary State Data Validation
Contact Email Address

D30

Back Up State Data Validation
Contact First Name

F30

Back Up State Data Validation
Contact Last Name

D31

Back Up State Data Validation
Contact Phone Number

F31

Back Up State Data Validation
Contact Phone Number
Extension

D32

Back Up State Data Validation
Contact Email Address

3.2

Valid Valies
Enter the email address for the
individual who is the primary
contact for the validation of this
data. Please make sure to include
the full email address (e.g.
[email protected]). The system will
validate that the @ is part of the
address.
Enter the first name of the
individual who is the back up
contact for the validation of this
data. The system allows up to 40
characters.
Enter the last name of the
individual who is the back up
contact for the validation of this
data. The system allows up to 40
characters.
Enter the phone number for the
individual who is the back up
contact for the validation of this
data. The system allows up to 15
characters.
Enter the phone number
extension for the individual who
is the back up contact for the
validation of this data. The
system allows up to 15
characters. THIS FIELD IS
OPTIONAL.
Enter the email address for the
individual who is the back up
contact for the validation of this
data. Please make sure to include
the full email address (e.g.
[email protected]). The system will
validate that the @ is part of the
address.

State Issuer & Product Info Tab

The following table includes the cell location for each data entry field on the State Issuer &
Product Info tab, along with appropriate values.

13

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
On this worksheet you will include one row for each Issuer/Market with offerings within your
state. If an Issuer has offerings in both the Individual and Small Group markets, you must create
two rows fir this issuer.
Cell Location

Data

B5

Issuer Name

C5

Individual/Small Group

D5

Issuer Data Submission
Contact Name

E5

Issuer Data Submission
Contact Phone Number

F5

Issuer Data Submission
Contact Email Address

G5

Customer Service Contact
Phone Number for Consumers

H5

No. of products offered - Fee
for Service

Valid Valies
Enter the name of the Insurance
Issuer.
Select Individual or Small
Group from the drop down. Do
not type in a value.
Enter the name of the individual
who is your point of contact at
the Issuer organization. The
system allows up to 40
characters.
Enter the phone number for the
individual who is your point of
contact at the issuer organization.
The system allows up to 15
characters.
Enter the email address for the
individual who is your point of
contact at the issuer organization.
Please make sure to include the
full email address (e.g.
[email protected]). The system will
validate that the @ is part of the
address.
Enter the phone number for the
individual who is your point of
contact at the Issuer
organization. The system allows
up to 15 characters. THIS FIELD
IS OPTIONAL.
Enter the number of Fee for
Service products the
corresponding Issuer offers for
the corresponding market
(Individual or SmallGroup). The
number must be a whole number.
If the Issuer does not offer any
Fee for Service products, enter 0.
Do not leave this field blank.

14

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
Cell Location
I5

J5

K5

L5

Data
No. of products offered HMO

Valid Valies
Enter the number of HMO
products the corresponding
Issuer offers for the
corresponding market (Individual
or SmallGroup). The number
must be a whole number. If the
Issuer does not offer any HMO
products, enter 0. Do not leave
this field blank.
No. of products offered - PPO Enter the number of PPO
products the corresponding
Issuer offers for the
corresponding market (Individual
or SmallGroup). The number
must be a whole number. If the
Issuer does not offer any PPO
products, enter 0. Do not leave
this field blank.
No. of products offered - EPO Enter the number of EPO
products the corresponding
Issuer offers for the
corresponding market (Individual
or SmallGroup). The number
must be a whole number. If the
Issuer does not offer any EPO
products, enter 0. Do not leave
this field blank.
No. of products offered - POS Enter the number of POS
products the corresponding
Issuer offers for the
corresponding market (Individual
or SmallGroup). The number
must be a whole number. If the
Issuer does not offer any POS
products, enter 0. Do not leave
this field blank.

15

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
Cell Location
M5

Data
No. of products offered Other

Valid Valies
Enter the number of Other
products the corresponding
Issuer offers for the
corresponding market (Individual
or SmallGroup). The number
must be a whole number. If the
Issuer does not offer any Other
products, enter 0. Do not leave
this field blank.

Please follow the following guidelines when entering data into this worksheet:
1) Do not skip any rows when entering data. The system will interpret an empty row as
the end of the data set (i.e. any data after a blank row will not be processed)
2) If you enter an Issuer Name in a row, you must enter all the required data for that
Issuer. Do not leave any of the required cells blank. All cells on that row are
required with the exception G5, Customer Service Phone Number.
3) If the Issuer does not have any products of a specific type, please make sure to enter
a 0 (zero) into the corresponding cell.
4) Any data entered within a row that does not have a corresponding Issuer Name will
not be processed.

16

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
4

Troubleshooting and FAQ

4.1

FAQ’s

Question 1: I am trying to open State Data Entry files in Excel 2007, but I do not see the Option
button. How do I enable contents?
1.

Click the Microsoft Office Button

2.

Click Trust Center, click Trust Center Settings, and then click Message Bar.

3.

Click the first radio button below:
•

4.2

, and then click Excel Options.

Show the Message Bar in all applications when document content has been blocked. This
option is selected by default so that you get Message Bar alerts whenever potentially
unsafe content has been disabled. The option is not selected if you clicked the Disable all
macros without notification option on the Macros pane of the Trust Center. If you click
Disable all macros without notification, you won't get Message Bar alerts when macros
are disabled.
Submission Information

Please submit your completed FINALIZED files via email to [email protected] .
Please remember not to change the name of the system-generated finalized file.
4.3

Support

HIOS Help
If you need additional assistance, please call the HIOS Help Desk at 1-877-343-6507 (available
beginning on Friday, May 7 2010) or email them at [email protected].

17

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
5
Appendix A— Critical Errors
5.1

State Data Critical Errors and Related Error Messages

These errors will prevent successful finalization.
1. State Data General Info, E3, State Name
a. Display error message if this field is blank.
b. Error Message: State name at E3 required.
2. State Data General Info, E4, Underwriting Status
a. Display error message if this field is blank.
b. Error Message: Underwriting Status at E4 is required.
3. State Data General Info, E6, State has interactive tool for small group market
a. Display error message if this field is blank.
b. Error Message: Small Group comparison tool at E6 is required
4. State Data General Info, E7, State website for small group
a. Display error message if this cell is blank.
b. Error Message: Website Address at E7 is required
5. State Data General Info, E9, State has interactive tool for individual market,
a. Display error message if field is blank.
b. Error Message: Individual Market comparison tool at E9 is required.
6. State Data General Info, E10, State website for individual market
a. Display error message if this cell is blank.
b. Error Message: Website Address at E10 is required
7. State Data General Info, D14, State Data Submission Primary Contact First Name
a. Display error message if cell is blank.
b. Error message: Submission Primary Contact name at D14 is required
8. State Data General Info, D15, Data Submission Contact Phone Number
a. Display the error message if the cell is blank.
b. Error message: Submission Primary Contact phone at D15 is required.
9. State Data General Info, D16, Data Submission Primary Contact email
a. Display error message if cell is blank.
b. Error Message: Submission Primary Contact email at D16 is required
10. State Data General Info, D25, Primary Contact First Name
a. Display error mesasge is cell is blank.
b. Error message: Preview Primary Contact name at D25 is required.
11. State Data General Info, D26, Primary Contact Phone Number
a. Display error message if cell is blank.
b. Error message: Preview Primary Contact phone at D26 is required.
12. State Data General Info, D27, Primary Contact email
a. Display error message if cell is blank.
b. Error message: Preview Primary Contact email at D27 is required.
13. State Data General Info, F14, Data Submission Primary Contact Last Name
a. Display error message if cell is blank.
b. Error message: Submission Primary Contact last name at F14 is required.
14. State Data General Info, F25, Data Validation Primary Contact Last Name

18

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
a. Display error message if cell is blank.
b. Error message: Preview Primary Contact last name at F25 is required.
15. State Data Issuer & Product Info, B5, Issuer Name
a. Display error message if cell is blank.
b. Error message: Issuer name at B5 is required.
16. State Data & Product Info, C5, Individual/Small Group
c. Display error message if value entered is not one of the options in the drop down
menu.
d. Error message: Individual/Small group at C5 is required.
17. State Data & Product Info, D5, Issuer Data Submission name
e. Display error message if value entered is not one of the options in the drop down
menu.
f. Error message: Issuer Data Submission name at D5 is required
18. State Data Issuer & Product Info, E5, Submission Contact Phone Number
g. Display error message if cell is blank.
h. Error message: Issuer Data Submission phone number at E5.
19. State Data & Product Info, F5, Submission Contact email.
i. Display error message if cell is blank.
j. Error message: Issuer Data Submission at F5 is required.
20. State Data & Product Info, H5, Fee-for-service
k. Display error message if cell is blank.
l. Error message: Fee-for-Service at H5 is required
21. State Data & Product Info, I5, HMO
m. Display error message if cell is blank.
n. Error message: Number of HMO at I5 is required
22. State Data & Product Info, J5, PPO
o. Display error message if cell is blank.
p. Error message: Number of PPO at J5 is required
23. State Data & Product Info, K5, EPO
q. Display error message if cell is blank.
r. Error message: Number of EPO at K5 is required
24. State Data & Product Info, L5, POS
s. Display error message if cell is blank.
t. Error message: Number of POS at L5 is required
25. State Data & Product Info, M5, Other/Describe
u. Display error message if cell is blank.
a. Error message: Other/describe at M5 is required

19

OMB Control Number: 0938-1086

Health Insurance Oversight System – Excel Data Submission Tool
Technical Instructions
6

Appendix B—Required Fields

State General Info Worksheet:
•
•
•
•
•
•
•
•
•
•

State Name
Underwriting Status
State Small Group Interactive Tool Yes/No
State Small Group Interactive Tool Website Address
State Individual Interactive Tool Yes/No
State Individual Interactive Tool Website Address
Primary Data Submission Contact: First Name, Last Name, Phone Number, Email
Address
Back Up Data Submission Contact: First Name, Last Name, Phone Number, Email
Address
Primary Data Validation Contact: First Name, Last Name, Phone Number, Email Address
Back Up Data Validation Contact: First Name, Last Name, Phone Number, Email
Address

State Issuer and Product Info Worksheet:
•
•
•
•
•

Issuer
Individual/Small Group Market
Issuer Contact: Name, Phone Number and Email Address
Issuer Contact Phone
Number of Products Offered for Each Product Type
 Fee for Service
 HMO
 PPI
 EPO
 POS
 Other

20

OMB Control Number: 0938-1086

Worksheet 1 - State General and Contact Information
1. General Information
1). State Name:
2). Underwriting Status:
3a). Does your State have an interactive health plan comparison tool for
the Small Group market?
3b). Enter the Website address for the Small Group market comparison
tool that includes benefits and prices for discrete plans; or enter the State
website address if "No" is entered above.

4a). Does your State have an interactive health plan comparison tool that
includes benefits and prices for discrete plans for the Individual market?
4b). Enter the Website address for the Individual market; or enter the
State website address if "No" is entered above.

2. State Data Submission Contacts
Primary Contact
First Name:

Last Name

Phone Number:

Extension:

Email:
Backup Contact
First Name

Last Name

Phone Number:

Extension:

Email:
3. State Data Submission Validation Contacts
Primary Contact
Name:

Last Name

Phone Number:

Extension:

Email:
Backup Contact
Name:

Last Name

Phone Number:

Extension:

Email:

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 0938-1086. The time required to complete this information collection
is estimated to average ( 10.17 hours) or (609.6 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.

OMB Control Number: 0938-1086

Worksheet 2 - Issuer and Product Information
Issuer Name

Individual/Small Group

Issuer Data Submission
Contact Name

Issuer Data
Submission Contact
Phone Number

Issuer Data
Submission Contact
Email

OMB Control Number: 0938-1086

OMB Control Number: 0938-1086
Customer Service Contact
Phone Number for Consumers

No. of Products
Offered - Fee-forService

No. of Products No. of Products
Offered - HMO Offered - PPO

No. of Products No. of Products No. of Products
Offered - Other
Offered - EPO
Offered - POS