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The Center for Consumer Information & Insurance Oversight

 

Health Insurance State-based Exchange Public Use Files

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is committed to increasing transparency in the Health Insurance Exchange. While health plan information including benefits, copayments, premiums, and geographic coverage is publicly available on the various State-based Exchange (SBE) websites, CMS has also released downloadable public use files (PUF) so researchers and other stakeholders may more easily access SBE data.

Currently, the State-based Exchange Public Use Files (SBE PUF) are available for the certified QHP plan year 2016, 2017, and 2018. State-based Exchanges that use the Federal Platform for QHP eligibility and enrollment functions (SBE-FPs) are not included in these files as they are included in the PUF for states on the Federal platform. It is important to note that the 2016,2017, and 2018 SBE PUF are published as of the dates indicated in the individual files.  This data will not be updated during the plan year.  

The SBE PUF include plan and issuer level information for certified qualified health plans (QHPs) and stand-alone dental plans (SADPs) offered to individuals and small businesses through the State-based Exchanges. The SBE PUF do not contain any enrollment or claims data.  Where a state operates only a SHOP Exchange (i.e., uses the Federal platform for its individual Exchange), only SHOP data are included in these PUF.  The data provided in the PUF were received from the National Association of Insurance Commissioners (NAIC), which extracted the data from their System for Electronic Rate and Form Filing (SERFF).  Only data available through the SERFF were included in the SBE PUF.  The SBE states were provided an opportunity to review and verify the data prior to its publication and many chose to do so.  Please see the notes below on the individual files for the verification status by state.

The SBE PUFs consists of six separate files as described below for each of the SBE states:

  • 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.

For more information about the SBE PUFs, please review the General Information Factsheet, Data Disclaimer-User Agreement and Data Dictionaries. For any further inquiries, please contact CMS at SBE_PublicUseFiles@cms.hhs.gov.

2016 Data Dictionaries 2017 Data Dictionaries 2018 Data Dictionaries
Benefits and Cost Sharing Data Dictionary Benefits and Cost Sharing Data Dictionary Benefits and Cost Sharing Data Dictionary
Rate Data Dictionary Rate Data Dictionary Rate Data Dictionary
Plan Attributes Data Dictionary Plan Attributes Data Dictionary Plan Attributes Data Dictionary
Business Rules Data Dictionary Business Rules Data Dictionary Business Rules Data Dictionary
Service Area Data Dictionary Service Area Data Dictionary Service Area Data Dictionary
Network Data Dictionary Network Data Dictionary Network Data Dictionary

To access and download each PUF, click on the associated link in the Downloads section below.

Downloads

2016 SBE PUF Datasets

Data current as of 10 February 2016
 

2017 SBE PUF Datasets

Data current as of 20 December 2016 (30 January 2017 for DC and MA)

2018 SBE PUF Datasets

Data current as of 30 January 2018

 
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