PY2017 to PY2018 Health Plan Information for Individual and Small Group Markets
Health Plan Information for Different Insurance Marketplaces PY2017 to PY2018
Keywords
Dental Plans
Medical Plans
Emergency Plans
Drug Formulary
Physicians Fees
Medical Charges
Emergency Costs
Health Insurance
Health Plan Information
Cost Sharing Plan
Standardized Plan Design
Individual and Family Health Plan Information PY2017 to PY2018
This dataset includes 2017 Individual and Family health plans available in the United States where the federal government is operating the Marketplace. It contains plan information for states in the Federally-facilitated Marketplaces and State Partnership Marketplaces: “Medical plans in the individual market”, “Medical plans in the small group (SHOP) market”, “Dental plans in the individual market” and “Dental plans in the small group (SHOP) market”.
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Last updated:January 20, 2021
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This dataset contains plan information for states in the Federally-facilitated Marketplaces and State Partnership Marketplaces:
– Medical plans in the individual market
– Medical plans in the small group (SHOP) market
– Dental plans in the individual market
– Dental plans in the small group (SHOP) market
States not represented in this dataset run their own Marketplaces. In addition to the above, it also includes data from plans in the State Based Marketplaces using the federal platform for eligibility and enrollment. The data were pulled from the Health Insurance Oversight System (HIOS) for Federally-facilitated states and the System for Electronic and Rate Form Filing (SERFF) for State Partnership states and State Based Marketplace states, and the Office of Personnel Management (OPM) for Multi-State Plans.
This dataset also includes different premiums for the following rating scenarios:
– Child = one child any age
– Adult Individual Age 21, 27, 30, 40, 50, and 60 = one adult age 21, 27, 30, 40, 50, or 60
– Couple 21, 30, 40, 50, and 60 = two adults age 21, 30, 40, 50, or 60, no children
– Couple + 1 child, Age 21, 30, 40, 50 = two adults age 21, 30, 40, or 50, and one child
– Couple + 2 children, Age 21, 30, 40, 50 = two adults age 21, 30, 40, or 50, and two children
– Couple + 3 or more children, Age 21, 30, 40, 50 = two adults age 21, 30, 40, or 50, and three or more children
– Single Parent + 1 child, Age 21, 30, 40, and 50 = one adult age 21, 30, 40, or 50, and one child
– Single Parent + 2 children, Age 21, 30, 40, and 50 = one adult age 21, 30, 40, or 50, and two children
– Single Parent + 3 or more children, Age 21, 30, 40, and 50 = one adult age 21, 30, 40, or 50, and three or more children
The above premium amounts do not include tax credits that will lower premiums for many consumers applying for insurance, specifically those with income up to 400 percent of the federal poverty level.
This dataset indicates whether the medical plan is a standardized plan design. An issuer may have up to five unique plans in each metal level that follow the standardized plan design for that metal level.
This information in this dataset also shows phone numbers and links to the following plan resources:
– Customer service phone numbers (local, toll-free, TTY)
– Network URL
– Plan brochure URL
– Summary of benefits URL
– Drug formulary URL
This dataset indicates whether the medical plan covers adult dental or child dental services. It also shows Essential Health Benefit (EHB) percent of total premium for each plan.
The dataset shows standard cost sharing information for each plan. Cost sharing information is shown for in-network services (showing first tier where there are multiple in-network tiers), and includes:
– Deductibles: For in-network medical care and drugs (by individual, family, family per person)
– Maximum out of pocket expenses: For in-network medical care and drugs (by individual, family, family per person)
– Copayments and coinsurance for the following in-network services:
– Primary care physician
– Specialist
– Emergency Room
– Inpatient facility
– Inpatient physician
– Generic drugs
– Preferred brand drugs
– Non-preferred brand drugs
– Specialty drugs
This dataset also shows cost sharing information for silver metal plans that are variants of the standard silver plan. Consumers that qualify for these silver plan variations based on their incomes and family size will see lower out-of-pocket costs. These plans differ from the standard plan by the percentage of health care expenses covered by the plan for a typical group of enrollees (i.e., actuarial value). The actuarial values of these silver plan variants are: 73 Percent Silver, 87 Percent Silver and 94 Percent Silver.
About this Dataset
Data Info
Date Created
2017-08-09
Last Modified
2018-01-26
Version
2018-01-26
Update Frequency
Annual
Temporal Coverage
2018
Spatial Coverage
United States
Source
John Snow Labs; HealthCare.gov;
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
Dental Plans, Medical Plans, Emergency Plans, Drug Formulary, Physicians Fees, Medical Charges, Emergency Costs, Health Insurance, Health Plan Information, Cost Sharing Plan, Standardized Plan Design
Other Titles
PY2017 to PY2018 Health Plan Information for Individual and Small Group Markets, Health Plan Information for Different Insurance Marketplaces PY2017 to PY2018
Data Fields
Name
Description
Type
Constraints
Year
Year of analysis
date
-
State
Full name of different states of U.S.
string
-
State_Abbreviation
Two-letter state abbreviation in the mailing address of the hospital.
string
-
FIPS_Code
The FIPS county code is a Federal Information Processing Standards (FIPS) code which uniquely identifies counties and county equivalents in the United States, certain U.S. possessions, and certain freely associated states.
string
-
County
Refers to the mailing county of the hospital.
string
-
Metal_Level
Indicates the insurance plan level. It includes the metal names: Bronze, Silver, Gold, Platinum and Catastrophic.
string
-
Issuer_Name
It includes the Health Insurance Plan provider atering to different states of U.S.
string
-
HIOS_Issuer_ID
It refers to the identity of the Health Insurance Oversight System (HIOS).
string
-
Plan_ID_Standard_Component
One of the basic components of Plan ID is the Standard Component ID. It is an alphanumeric code to identify a particular plan.
string
-
Plan_Marketing_Name
Refers to the name of the Health Insurance Plan which the companies used for their marketing.
string
-
Plan_Type
Indicates the type of Health Insurance Plans. It includes four types of plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Point Of Service (POS).
string
-
Standardized_Plan_Design
It refers to the plan designs that all insurers are required to sell in the marketplace that has standardized cost-sharing for covered health services. This dataset comprises five Standard Plan Designs.
string
-
Rating_Area
Under the Affordable Care Act (ACA), each state has submitted a plan to divide up the areas of the state into locations called Rating Areas. Depending on the state, these geographical units will eiher be made up of counties, metroplitan statistical areas or 3 digit zip codes. These state groupings will be submitted to The Department of Human Health Services (HHS) for approval and will then be used by insurers to price premiums. This dataset includes 67 Rating Areas.
string
-
Child_Only_Offering
Refers to the information that the Health Insurance Plan is either Adult-Only or Adult and Child-Only.
string
-
Source
Indicates the source from where data has been collected. It includes: Health Insurance Oversight System (HIOS), Office of Personnel Management (OPM) and System for Electronic Rate and Form Filing (SERFF).
string
-
Customer_Service_Phone_Number_Local
Refers to the local phone number to contact customer service.
string
-
Customer_Service_Phone_Number_Toll_Free
Refers to the Toll Free phone number to contact customer service.
string
-
Customer_Service_Phone_Number_TTY
Refers to the TeleTYpewriter (TTY) phone number to contact customer service. TTY refers to the Telecommunication Device for the Deaf also abbreviated as TDD.
string
-
Network_URL
Indicates the Universal Resource Locator (URL) of the Health Insurance Network.
string
-
Plan_Brochure_URL
Refers to the Universal Resource Locator (URL) of the Health Insurance Plan Brochure.
string
-
Summary_of_Benefits_URL
Indicates the Universal Resource Locator (URL) of the Health Insurance Summary of Benefits.
string
-
Drug_Formulary_URL
Refers to the Universal Resource Locator (URL) of the Health Insurance Drug Formulary.
string
-
Accreditation
The information included in this dataset is accredited to: National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC).
string
-
Is_Adult_Dental_Allowed
Refers to the information whether the Health Insurance Plan covers Adult Dental services or not.
boolean
-
Is_Child_Dental_Allowed
Refers to the information whether the Health Insurance Plan covers chid Dental services or not.
boolean
-
EHB_Percent_of_Total_Premium
The Affordable Care Act requires that non-grandfathered, insured health plans offered in the individual and small group markets, both inside and outside of the Exchanges, provide a core package of health care services, known as "Essential Health Benefits (EHB)".
number
level : Ratio
Premium_Child_In_Dollars
Indicates the child premium amount in dollars within Premium Scenarios.
number
-
Premium_Individual_Adult_At_Age0_to_14_In_Dollars
This Premium Scenario refers to the premium amount in dollars for Adults at age of 0 to 14 years.
number
-
Premium_Individual_Adult_At_Age18_In_Dollars
This Premium Scenario refers to the premium amount in dollars for Adults at age of 18 years.
number
-
Premium_Individual_Adult_At_Age21_In_Dollars
This Premium Scenario refers to the premium amount in dollars for Adults at age of 21 years.
number
-
Premium_Individual_Adult_At_Age27_In_Dollars
This Premium Scenario indicates the premium amount in dollars for Adults at age of 27 years.
number
-
Premium_Individual_Adult_At_Age30_In_Dollars
This Premium Scenario refers to the premium amount in dollars for Adults at age of 30 years.
number
-
Premium_Individual_Adult_At_Age40_In_Dollars
This Premium Scenario indicates to the premium amount in dollars for Adults at age of 40 years.
number
-
Premium_Individual_Adult_At_Age50_In_Dollars
This Premium Scenario refers to the premium amount in dollars for individual Adult at Age of 50 years.
number
-
Premium_Individual_Adult_At_Age60_In_Dollars
This Premium Scenario refers to the premium amount in dollars for individual Adult at Age of 60 years.
number
-
Premium_Couple_at_Age21_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 21 years.
number
-
Premium_Couple_at_Age30_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 30 years.
number
-
Premium_Couple_at_Age40_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 40 years.
number
-
Premium_Couple_at_Age50_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 50 years.
number
-
Premium_Couple_at_Age60_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 60 years.
number
-
Premium_Couple_Plus1_Child_At_Age21_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 21 years with one child.
number
-
Premium_Couple_Plus1_Child_At_Age30_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 30 years with one child.
number
-
Premium_Couple_Plus1_Child_At_Age40_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 40 years with one child.
number
-
Premium_Couple_Plus1_Child_At_Age50_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 50 years with one child.
number
-
Premium_Couple_Plus2_Children_At_Age21_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 21 years with two children.
number
-
Premium_Couple_Plus2_Children_At_Age30_In_Dollars
This Premium Scenario refers to the premium amount in dollars for the Couple at Age of 30 years with two children.
number
-
Premium_Couple_Plus2_Children_At_Age40_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 40 years with two children.
number
-
Premium_Couple_Plus2_Children_At_Age50_In_Dollars
This Premium Scenario indicates the premium amount in dollars for the Couple at Age of 50 years with two children.
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