Use Case 50: Incomplete Data in 2015 Rate PUF

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Requirements

Use case summary

Description

  • This use case was originally submitted because it appeared to the user that the 2015 Rate PUF (within the Marketplace PUF) only contained rate information for sources from HIOS (Health Insurance Oversight System); it did not appear to contain rate information from SERFF (System for Electronic Rate and Form Filing) and OPM (Office of Personnel Management). In contrast, the 2015 Plan Attributes PUF contains data from all three sources, HIOS, SERFF, and OPM.

Current data and limitation

  • Data source: Marketplace PUF
    • URL: https://www.cms.gov/cciio/resources/data-resources/marketplace-puf.html
      • URL has data dictionaries and PUF downloads
    • The Marketplace PUF consists of eight separate files:
      • Benefits and Cost Sharing PUF (BenCS-PUF) – Plan-level data on essential health benefits, coverage limits, and cost sharing.
      • Rate PUF (Rate-PUF) – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
      • Plan Attributes PUF (Plan-PUF) – Plan-level data on maximum out of pocket payments, deductibles, cost sharing, HSA eligibility, formulary ID, and other plan attributes.
      • Business Rules PUF (BR-PUF) – Plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents) and tobacco use.
      • Service Area PUF (SA-PUF) – Issuer-level data on the geographic coverage or service area (i.e., where the plan is offered) including state, county, and zip code.
      • Network (Ntwrk-PUF) – Issuer-level data identifying provider network URLs.
      • Plan ID Crosswalk PUF (CW-PUF) – Plan-level data mapping plans offered in 2014 to plans offered in 2015.
      • Machine-readable URL PUF (MR-PUF)—Issuer-level URL locations for machine-readable plan network provider and formulary information
    • General info factsheet for Marketplace PUF: https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/General-Information-Factsheet.pdf

Specifications

  • Fields: SourceName
  • Update frequency:
    • 2016 Marketplace PUF available as of November 4, 2015
    • 2015 Marketplace PUF available as of July 24, 2015
    • 2015 Marketplace PUF available as of July 30, 2014
  • History: 2014, 2015, and 2016
  • Delivery mechanism: PUF download

Solution

  • The 2016 Rate PUF released in on 4 November 2015 contains information from all three sources, HIOS, SERFF, and OPM. It also appears that the 2015 Rate PUF contains data from these sources; the information originally believed to be missing may have been due to file truncation.
  • The Rate PUF file is extremely large and may not load completely in Excel. An incomplete load of the PUF into Excel will result in apparently missing data. Please use another statistical or database package to load large PUFs (the Benefit and Cost Sharing PUF and Rate PUF).

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