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An Overview of the 2014 QHP Templates
Last Updated: February 13, 2014

On November 20, 2012, CMS published CMS Form Number: CMS-10433: Initial Plan Data Collection to Support QHP Certification and other Financial Management and Exchange Operations. A part of the collection of this data will be in the form of Microsoft Excel workbooks with embedded Macros which will assist the filing issuers as they gather and enter the required data elements. These Microsoft Excel workbooks are referred to as "templates" and are intended to create a nationwide standard of plan- and issuer-level data collection for the use of QHP certification, exchange operations, and oversight activities.

The templates below represent the final versions that will be used by issuers to use in applying for certification to participate in the Federally-facilitated Exchanges and State Partnership Exchanges. Most State Based Exchanges will also use these templates. Please note that external testing of the templates will occur through the month of March, the results of which may lead to minor changes in the templates to be used for final QHP application submission. The plans and benefits template will be released with the latest add-in file versions of the state-specific benchmark data and AV calculator.

Template Name Template Description Version Download
Administrative Template
(Updated 4/23/2013)
Collects general company and contact information. 3.22 Administrative Data Template
ECP Template Collects identifying information for Essential Community Providers. 3.2 Essential Community Providers Template

Plan/Benefit Template
(Updated 5/16/2013)

Collects plan and benefit data for medical and dental.

1.32 Plans and Benefits Template Instructions
Plans Benefits Template
Plans Benefits Add-In
(Updated 5/22/2013)
Collects plan and benefit data, including changes for dental.

The updated file corrected discrepancies some issuers encountered between the Benefits Template and the Stand Alone AV Calculator. Also enables issuers to change the Plan Marketing Name in the Benefits Template.

1.34 Plans Benefits Add-In
Prescription Drug Template
(Updated 4/23/2013)
Collects formulary data for plans.

The updated file corrected a defect for some issuers who need to enter "0" for copays and co-insurance.

1.64 Prescription Drug Template
Network Template
(Updated 4/23/2013)
Information identifying a provider’s network. 1.71 Network Template
Service Area Template Information identifying a plan’s geographic service area. 2.91 Service Area Template

Rate Data Template
(Updated 5/22/2013)

Rating Tables

The updated file corrected defect for some issuers who experience problem due to rounding errors for non-tobacco rates.

2.3 Rates Template
Business Rule Template Supporting business rules 1.5 Business Rules Template
Accreditation Templates Collects information related to an issuer's NCQA and/or URAC accreditation status. 1.6
1.4
Issuers NCQA Template
Issuers URAC Template
Unified Rate Review Template
(Updated 2/13/2014)
This is a federal data collection template designated to capture information at the market level, consistent with the requirement to set premium rates using a single risk pool. 1.6 Unified Rate Review Template

Instructions and Helpful Information

Instructions for QHP Submissions
Instructions for Stand-Alone Dental Submissions
QHP Dental Frequently Asked Questions
Copying and Pasting in Templates
QHP Template Prep
Rates Table Template Instructions
Part I Unified Rate Review Template Instructions
Part III Actuarial Memorandum and Certification Instructions

The information below represents the technical specifications necessary for receiving and storing the data represented in the templates above. This information will only be used by state-based exchange teams as they build their systems to receive and display the plan data for use on the state’s exchange portal.

File Category

Description

Download

Data Traceability Matrix (DTM)

These files describe the data elements in the templates and the high-level business rules for each element.

FFE_PM_IssuerApp_Template_DTM
FFE_PM_PlansBenefits_Template_DTM
FFE_PM_Rate Review_Template_DTM
FFE_Rate_Data_Collection_Template_DTM
PM_Common_URR_Data Dictionary.xlsx

Information Exchange Package Documentation (IEPD)

These files describe the NIEM compliant schemas reflected in the XML that will be transferred between the SERFF, HIOS, and Exchange systems.

Admin_Data_IEPD_v1.2.1.zip
Network_Provider_IEPD_v1.1.2.zip
Rate_Business_Rules_IEPD_v1.1.zip
Service_Area_IEPD_v1.1.zip

Schema/XSD files

These files describe the format of the data exchange between the SERFF, HIOS, and Exchange systems.

Xsd.zip

 

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