CMS-10433 Rate Table Template

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

AppG_NONFUNCTIONAL_RateTables.xls

QHP Certification

OMB: 0938-1187

Document [xlsx]
Download: xlsx | pdf

All fields with an asterisk (*) are required. To validate press Validate button or Ctrl + Shift + I. To finalize, 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 B1 through B5. If you are in a community rating state, select Family-Tier Rates under Rating Method and fill in all columns.



If you are not in a community rating state, select Age-Based Rates under Rating Method 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 + H. All plans must have the same dates on a sheet.


HIOS Issuer ID*



Federal TIN*



Rate Effective Date*



Rate Expiration Date*



Rating Method*












Plan ID* Rating Area ID* Tobacco* Age* Individual Rate*
Required:
Enter the 14-character Plan ID
Required:
Select the Rating Area ID
Required:
Select if Tobacco use of subscriber is used to determine if a person is eligible for a rate from a plan
Required:
Select the age of a subscriber eligible for the rate
Required:
Enter the rate of an Individual Non-Tobacco or No Preference enrollee on a plan











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

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