How to Complete the Rates Table Template
Issuers seeking to offer qualified health plans, or QHPs,
including stand-alone dental plans, or SADPs, on the Federally-facilitated Exchange must submit a
completed QHP Application per CMS guidelines. As part of the QHP certification process,
issuers are asked to fill out several templates with issuer- and plan-level data. These templates,
along with any supporting documentation submitted, comprise an issuer’s QHP Application.
Among these templates is the Rates Table Template. The Rates Table Template defines
the rates the issuer will charge for each subscriber the plan covers. This template
is used in conjunction with the Business Rules Template to calculate enrollment group premiums.
To download the Rates Table Template and applicable instructions,
visit the Rates webpage of the QHP certification website.
This webpage contains more information about the Rates section of the QHP Application,
including tips and additional resources. Before filling out the Rates Table Template,
download and read the instructions from the Application Resources section.
Once you’re ready to complete the Rates Table Template, download the template
from the Application Resources section, open the template, and enable macros.
You must enter rate information for each QHP and SADP you plan to offer,
in each rating area of each service area defined in the Service Area Template.
QHP rate information should be entered on different worksheets than SADP rate information.
Note that issuers submitting in the Health Insurance Oversight System, or HIOS, must
submit a single Rates Table Template that contains rate data for all plans offered, including SADPs.
Issuers should also create separate worksheets for Individual market plans
and Small Business Health Options, or SHOP, plans. Issuers submitting SHOP quarterly rates must
report rates for each quarter on separate worksheets in the Rates Table Template.
All plans within each worksheet must have the same rate effective and rate expiration dates.
When filling out templates in the QHP Application, start in the top left corner,
and fill out fields moving down and to the right until all required fields are completed.
Now let’s walk through filling out the Rates Table Template with sample data.
Before you begin, look through the data elements required to ensure
you have the necessary plan information to successfully complete this template.
To begin, enter the 5-digit HIOS Issuer ID you received when you registered in HIOS.
Next, enter the rate effective date and rate expiration date. Each date should follow the
format shown on the screen. For individual market plans and SHOP plans without trended quarterly
rates, the effective date must be equal to January 1st for the plan year, and the expiration
date must be December 31st of the plan year. For SHOP plans with trended quarterly rates,
the rate effective and expiration dates must correspond with the calendar quarters.
Possible effective dates include January 1st, April 1st, July 1st, or October 1st.
Possible expiration dates include March 31st, June 30th, September 30th, or December 31st.
Note that you must fill in the rate effective date range for each worksheet in this template.
The next data element is the rating method. In this field,
indicate whether the plans listed use age-based rates or family tier rates.
If you select family-tier rates, seven additional required fields will populate in the template.
Note that only issuers in states that do not permit rating for age or tobacco use and SADP
issuers are eligible to select family tier rates. The next item in the template is the “Add
Sheet” button. Use this button in the following situations:
To separate individual market plan rates from SHOP plan rates;
To separate medical plan rates from dental plan rates;
To separate dental and medical plans with family tier rates from those with age-based rates; and
To separate SHOP plans with different rate effective and expiration dates,
since all plans in a single worksheet must have the same effective date range.
Next, in the cell below the “Plan ID” heading, enter the 14-character HIOS-generated plan ID
that identifies the plan associated with rates to be entered in this row.
In the Rating Area ID column, select the rating area or areas from the pop-up that appears when
you choose “Click here to select” from the dropdown. Note that rates will apply to all
selected rating area IDs. A rating area is the geographic area where the rates entered in the
row are valid. For a list of rating areas in each state, visit the CCIIO website.
Each state may assign rating areas differently. For example, in some states, the individual and
SHOP markets have different rating areas. Be sure to check the CCIIO website for your state’s
rating areas and submit rates for every rating area that is associated to your service areas.
Plans in service areas without rates will not be displayed to consumers on HealthCare.gov.
For issuers with age-based rates,
use the “Tobacco” field to indicate whether rates will vary based upon tobacco use.
If rates are different for tobacco users compared to non-tobacco users,
select “Tobacco User/Non-Tobacco User,” and enter rates for both the “Individual Rate” and
“Individual Tobacco Rate” options. Note that a QHP rating by tobacco use must enter the same values
for the non-tobacco and tobacco rate columns for the underage age bands of 0 through 20.
If the same rates apply to both tobacco and non-tobacco users,
select “No Preference” in the “Tobacco” column. Note that SHOP medical plans must offer a wellness
program designed to prevent or reduce tobacco use, as indicated in the Plans & Benefits Template.
If the plan does not offer a wellness program, it cannot rate for tobacco use.
For issuers with age-based rates, the template will automatically generate a row for each age
band, beginning with “0-14” and continuing through “64 and over.” Enter the applicable rates in the
“Individual Rate” column for each row. Based on federal market rules, individual rates cannot
vary based on age by more than three times the rate for age 21, and tobacco rates cannot be more
than 1.5 times higher than the corresponding non-tobacco rate within a single age band.
A list of states that follow an age curve that differs from the federal age curve is
available on the CCIIO website. If your state does not have a state-specific age curve,
follow the federal age rating curve. For issuers that select “Family Tier
Rates” in the rating method dropdown menu, the template automatically generates seven additional,
required columns. Select the Rating Area ID and enter the individual rate for the associated plan.
Tobacco rates are not available for family tier rates, so tobacco-related fields have been hidden.
Next, enter the rate for couples in the “Couple” column. A couple is defined as
a primary subscriber and spouse or life partner. Then, enter rates for the following six columns.
Once these fields are complete, continue filling out the Rates Table Template until all rates
and associated information has been entered. Now, let’s validate and finalize the template.
Once you have completed the template, click the “Validate” button in the top left corner of the
worksheet. Any data issues in your template that need to be resolved will be displayed;
correct these and click the Validate button again. Continue
this process until all errors have been resolved. Once the template is valid, click the “Finalize”
button to create an XML that will be automatically saved in the same folder as the template.
The XML extract is the file you will submit as part of your QHP Application.
If you have questions regarding your QHP Application, please
contact the Marketplace Service Desk at CMS_FEPS@cms.hhs.gov or 855-CMS-1515.
For more information about the QHP certification process, visit www.qhpcertification.cms.gov.