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An Overview of the 2015 QHP Templates
Last Updated: 5/14/2014

Template Name Template Description Version Download
Administrative Template
(Updated 4/17/2014)
Collects general company and contact information. 4.0 Administrative Data Template
ECP Template
(Updated 4/17/2014)
Collects identifying information for Essential Community Providers. 4.0 Essential Community Providers Template
Plan/Benefit Template
(Updated 4/17/2014)
Collects plan and benefit data for medical and dental. 4.0 Plans and Benefits Template Instructions
Plans Benefits Template
Plans Benefits Add-In
(Updated 5/14/2014)
Collects plan and benefit data, including changes for dental. 4.1 Plans Benefits Add-In
Plan Benefits Revised Benchmarks
(Updated 5/23/2014)
Provides revised benchmarks for each state and instructions for updating the Plan and Benefits template accordingly 2.0

Revised Benchmark Spreadsheet SHOP
Revised Benchmark Spreadsheet Individual
Prescription Drug Template
(Updated 4/17/2014)
Collects formulary data for plans. 4.0 Prescription Drug Template
Network Template
(Updated 4/17/2014)
Information identifying a provider’s network. 4.0 Network Template
Service Area Template
(Updated 4/17/2014)
Information identifying a plan’s geographic service area. 4.0 Service Area Template
Rate Data Template
(Updated 4/17/2014)
Rating Tables 4.0 Rates Template
Business Rule Template
(Updated 4/17/2014)
Supporting business rules 4.0 Business Rules Template
Accreditation Templates
(Updated 4/17/2014)
Collects information related to an issuer's NCQA and/or URAC accreditation status. 4.0
Issuers NCQA Template
Issuers URAC Template
Issuers AAAHC Template
Unified Rate Review Template
(Updated 4/17/2014)
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. 2.0.2

Part I Unified RR Instructions
Part III Actuarial Memorandum and Certification Instructions

Unified Rate Review Template
Network Adequacy Template
(Updated 5/15/2014)
  1.0 Network Adequacy Template
Release of Final Plan ID Crosswalk Template and Instructions
(Updated 8/11/2014)
The Plan ID Crosswalk template will be used by issuers to map 2014 Qualified Health Plan (QHP) or Stand Alone Dental Plan (SADP) Plan ID and service area combinations (e.g., Plan ID and County combinations) to a 2015 Plan ID.   Final Plan ID Crosswalk Template


State Authorization of 2015 QHP Plan ID Crosswalk A state may choose to use this form as evidence that the issuer is authorized to submit its Plan ID Crosswalk. Use of this form is optional and a state may choose to develop its own form or method for documenting evidence of state authorization. 1.0 State Authorization of 2015 QHP Plan ID Crosswalk

Instructions and Helpful Information

Supporting Documentation and Instructions
Copying and Pasting in Templates

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


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_2015
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. Coming Soon...
Schema/XSD files These files describe the format of the data exchange between the SERFF, HIOS, and Exchange systems. Coming Soon...


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