Health Insurance Oversight System Rate & Benefits .
Health Insurance Oversight SystemRate & Benefits Information SystemUser ManualVersion 08.00.00August 2020
HIOS RBIS User Manual v 08.00.00Table of ContentsTable of Contents . iTable of Figures . ivTable of Tables . viRBIS User Manual Change History . viiIntroduction . 111.1Instructional Layout . 1Getting Started . 222.1Minimum Requirements . 22.1.1Macro Security Level Setting . 22.1.2Set-up Configurations . 22.1.2.1Excel Version 2013 or later. 32.2Marketplace Service Desk. 32.3User Registration . 32.4Accessing the System. 32.4.13Log-In . 3Process Overview . 53.1Role Overview . 53.2Submitter Process . 53.3Validator Process . 83.4Attester Process . 93.5Resubmission Process . 93.6Finder.Healthcare.gov Refresh . 93.6.1Interim Refresh . 103.6.2Final Refresh . 104RBIS Home Page . 114.1RBIS Announcements . 114.2RBIS Related Links . 124.3User Association Table. 12Submission Summary . 1355.1Submission Summary Search Criteria . 135.2Submission Summary Search Results . 14HIOSRBIS User Manual – Last Updated August 2020Page i
HIOS RBIS User Manual v 08.00.005.2.16Submission Summary Results - Possible Values and their Meanings . 16Submission Materials . 186.1Instructions and Reference Materials . 186.2Download Submission Materials . 18Templates . 2077.1Plans and Benefits Template . 207.1.1Plans and Benefits Template Add-In . 227.1.2AV Calculator . 227.2Service Area Template . 227.3Rates Template . 237.4Business Rules Template . 247.5URL Template . 247.6Template Validation & Finalization Processes . 258Data Upload . 26Data Upload – Small Group and Individual Market . 278.18.1.1Upload Files . 278.2Uploaded Files History for Small Group and Individual Markets . 288.3Submission Complete . 298.3.1Template Validations – Stage 1 . 308.3.2Cross-Check Validations – Stage 2 . 319Validate Data . 32Validate Data . 339.19.1.1View All Plans Views . 349.1.1.1View Issuer ID . 349.1.1.2No Data Received for Issuer ID(s) . 359.1.1.2.19.1.1.39.1.210Validation Status . 39Search by Scenario Views . 419.1.2.1Search Criteria Required Fields – Individual and Small Group Markets. 419.1.2.2ZIP Code . 439.1.2.3Search Results . 43Attestation . 4610.1HIOSNo Data to Report for Issuer ID(s) . 36Attestation Available . 46RBIS User Manual – Last Updated August 2020Page ii
HIOS RBIS User Manual v 08.00.0010.2Attestation Unavailable . 4710.3Attestation Complete . 4810.4Manual Attestation . 4911Resubmission . 5011.1Resubmission Requirements . 5011.2Resubmission Validation and Attestation Requirements . 5012Appendices . 5112.1Appendix A – Template Data Validations . 5112.2Appendix B - File Type Instructions . 5112.2.1XML . 5112.2.2ZIP . 5112.2.3Saving Documents in .ZIP Format . 5212.3HIOSAppendix C - Business Rules and Rates Template Integration . 5212.3.1Business Rules Template Guidelines . 5312.3.2Age Calculation for Eligibility and Quote Determination . 5312.3.3Rates Template Guidelines . 5412.3.4Sample Rate Calculations . 57RBIS User Manual – Last Updated August 2020Page iii
HIOS RBIS User Manual v 08.00.00Table of FiguresFigure 1: Access the RBIS System Link on the RBIS Submissions Tab . 4Figure 2: RBIS Submitter Role Flowchart . 6Figure 3: RBIS Validator Role Flowchart. 8Figure 4: RBIS Attester Role Flowchart . 9Figure 5: RBIS Home Page . 11Figure 6: Submission Summary Page . 13Figure 7: Submission Summary Page Selection Examples . 14Figure 8: Submission Summary Page Search Results Table . 15Figure 9: Instructions and Reference Materials . 18Figure 10: Download Data Submission Materials . 19Figure 11: Plans and Benefits Template for Individual and Small Group Plans . 21Figure 12: Invalid Data – Format is Invalid . 21Figure 13: Plans and Benefits Add-In Module Available Functions . 22Figure 14: Service Area Template for Individual and Small Group Plans . 23Figure 15: Rates Template for Individual and Small Group Plans . 23Figure 16: Business Rules Template for Individual and Small Group Plans . 24Figure 17: RBIS URL Template for Individual and Small Group Plans . 25Figure 18: Data Upload Tab. 26Figure 19: HIOS Product Data Upload Confirmation – Individual Market Example. 27Figure 20: Files Selected to Upload – Small Group Market Example . 28Figure 21: Uploaded Files History . 29Figure 22: Validate Data tab – Individual Market Example . 33Figure 23: View All Plans - Select Issuer ID(s) . 34Figure 24: Issuer ID Multi-Select Example . 35Figure 25: No Data Received for Issuer ID(s) – Small Group Market Example . 36Figure 26: No Data to Report for Issuer ID(s) (Example from Small Group Market) . 37Figure 27: View All Plans – Issuer Benefit Details . 38Figure 28: Benefit Details for Individual Plans – Individual Market . 39Figure 29: View All Plans - Validation Status . 40Figure 30: Search Criteria – Small Group Market . 42Figure 31: ZIP Code Field . 43HIOSRBIS User Manual – Last Updated August 2020Page iv
HIOS RBIS User Manual v 08.00.00Figure 32: Search by Scenario Screen – Small Group Market Example . 44Figure 33: Search by Scenario Results Table – Small Group Market Example . 45Figure 34: Attestation Available . 47Figure 35: Attestation Unavailable . 48Figure 36: Attestation Complete . 48Figure 37: Example Scenario 1 – Group Rate Results . 58Figure 38: Example Scenario 1 – Group Rate Results . 58Figure 39: Example Scenario 2 – Individual Rate Results . 59Figure 40: Example Scenario 2 – Group Rate Results . 60Figure 41: Example Scenario 3 – Individual and Group Rate Results. 61HIOSRBIS User Manual – Last Updated August 2020Page v
HIOS RBIS User Manual v 08.00.00Table of TablesTable 1: Submission Summary Detailed Result Values . 16Table 2: Subscriber Type Mapping for Individual Rate Calculations . 54Table 3: Subscriber Type Mapping for Group Rate Calculations . 55Table 4: Example Scenario 1 - Individual Rate Calculation . 57Table 5: Example Scenario 1 – Group Rate Calculation . 58Table 6: Example Scenario 2 - Individual Rate Calculation . 59Table 7: Example Scenario 2 - Group Rate Calculation No Plans Returned . 60Table 8: Example Scenario 2 - Group Rate Calculation Plans Returned . 60Table 9: Example Scenario 3 – Individual and Group Rate Calculation . 61HIOSRBIS User Manual – Last Updated August 2020Page vi
HIOS RBIS User Manual v 08.00.00RBIS User Manual Change HistoryAugust 2020 RevisionsThe following sections in this document have been updated to support Release 18.00.00:The sections below contain updated text information: Added new section 7.5 describing the submission and validation process of the new URLtemplateUpdated informative text for the URL template in the following sections 2.1 , 3.2 , 6.2, 7 and8.3.2Removed text describing the “Yes, Do not Display” option from section 9.1.1.3 as its no longerdisplayedThe sections below contain updated screenshots: Section 6.2 - Updated Figure 10 screenshot with the latest Download Data Submission Materials Section 7.1 - Updated Figure 11 screenshot with 2021 Plan Benefits template Section 7.1 - Updated Figure 12 screenshot to display invalid data message on 2021 PlanBenefits template Section 7.2 - Updated Figure 14 screenshot with 2021 Service Area template Section 7.3 - Updated Figure 15 screenshot with 2021 Rates Template Section 7.4 - Updated Figure 16 screenshot with 2021 Business Rules Template Section 7.5 – Added Figure 17 screenshot with 2021 URL Template Section 8.1.1 – Updated Figures 19 and 20 screenshots with latest Files Selected to Upload forSmall Group Market and Individual Market Example Section 9.1.1.3 - Updated Figure 29 screenshot of View All Plans- Validation StatusAugust 2019 RevisionsThe following sections in this document have been updated to support Release 17.00.00:The sections below contain updated text information: Added text stating that reattestations are no longer necessary for data resubmission for thefollowing sections 3.2 and 3.3The sections below contain updated screenshots: HIOSSection 7.1 - Updated Figure 11 screenshot with 2020 Plan Benefits templateSection 7.1 - Updated Figure 12 screenshot to display invalid data message on 2020 PlanBenefits templateSection 7.2 - Updated Figure 14 screenshot with 2020 Service Area templateSection 7.3 - Updated Figure 15 screenshot with 2020 Rates TemplateSection 7.4 - Updated Figure 16 screenshot with 2020 Business Rules TemplateRBIS User Manual – Last Updated August 2020Page vii
HIOS RBIS User Manual v 08.00.00May 2019 RevisionsThe following sections in this document have been updated to support Release 16.00.00:The sections below contain updated text information: Section 8 - Changed page title from “View Uploaded Files” to “Uploaded Files History”Section 8.2 - Updated all references to “View Uploaded Files” to display new page title“Uploaded Files History”Section 9.1.2.1 – updated text from “Primary subscriber” to “Person primarily seeking coverage”and “Secondary subscriber” to “Primary’s spouse or life partner seeking coverage”The sections below contain updated screenshots: HIOSSection 2.4.1 – Updated Figure 1 of RBIS Submissions Tab on Landing PageSections 4 – 6o Updated Figure 5 of RBIS Home Pageo Updated Figure 6 of Submission Summary Pageo Updated Figure 7 of Submission Summary Page Selection Exampleso Updated Figure 8 of Submission Summary Page Search Results Tableo Updated Figure 9 of Instructions and Reference Materialso Updated Figure 10 of Download Data Submission MaterialsSections 8 – 11o Updated Figure 17 of Data Upload Tabo Updated Figure 18 of HIOS Product Data Upload Confirmation – Individual MarketExampleo Updated Figure 19 of Files Selected to Upload – Small Group Market Exampleo Updated Figure 20 of Uploaded Files Historyo Updated Figure 21 of Validate Data tab – Individual Market Exampleo Updated Figure 22 of Select Issuer ID(s) – Individual Market Exampleo Updated Figure 23 of Issuer ID Multi-Select Exampleo Updated Figure 24 of No Data Received for Issuer ID(s) – Small Group Market Exampleo Updated Figure 25 of No Data to Report for Issuer ID(s) (Example from Small GroupMarket)o Updated Figure 26 of View Benefit Details for Individual Plans – Individual MarketExampleo Updated Figure 28 of Validation Status – Individual Market Exampleo Updated Figure 29 of Search Criteria – Small Group Marketo Updated Figure 30 of Zip Code Fieldo Updated Figure 31 of Search by Scenario Search Screen – Small Group Market Exampleo Updated FigureF 32 of Search by Scenario Results Table – Small Group Market Exampleo Updated Figure 33 of Attestation Availableo Updated Figure 34 of Attestation Unavailableo Updated Figure 35 of Attestation Completeo Updated Figure 36 of Email Opt-Out CheckboxRBIS User Manual – Last Updated August 2020Page viii
HIOS RBIS User Manual v 08.00.00August 2018 RevisionsThe following sections in this document have been updated to support Release 15.00.00:The following sections contain updated text information:Section 2.1 - Removed “Simple Choice Plan Add In – xlsm” from list of Minimum RequirementsSection 2.2 - Changed all references from Exchange Operations Service Desk (XOSC) withMarketplace Service Desk (MSD) Section 3.2 - Added important information regarding the new RBIS Annual submission process Section 3.4 - Added text regarding Attestation process enhancements (Attesters will only needto attest once, throughout the entire submission year) Section 3.5 - Added text stating that reattestations are no longer necessary for dataresubmission Section 6.2 - Added verbiage regarding IFP and SMG templates Section 7 - Added information regarding template version Section 8.3.1 - Added text explaining template validation to check for correct template versionused Section 9.1.2.1 and 9.1.2.2 - Combined sections into 9.1.2.1 to display Search Criteria requriedFields - Individual and Small Group Markets Section 11.1 and 11.2 – Updated information regarding Resubmission requriements andResubmssion Validation and Attestation requirementsThe following sections contain updated screenshots: HIOSSection 4 - Updated Figure 5 screenshot of RBIS Home PageSection 6.2 - Updated Figure 10 screenshot of consolidated Submission Materials tab for IFP andSMG MarketsSection 7.1 - Updated Figure 11 screenshot with 2019 Plan Benefits templateSection 7.1 - Updated Figure 12 screenshot to display invalid data message on 2019 PlanBenefits templateSection 7.2 - Updated Figure 14 screenshot with 2019 Service Area templateSection 7.3 - Updated Figure 15 screenshot with 2019 Rates TemplateSection 7.4 - Updated Figure 16 screenshot with 2019 Business Rules TemplateSection 9.1.2.4 - Updated Figure 31 screenshot to show “required fields” populated with dataSection 11.3 - Updated Figure 36 screenshot to show updated RBIS Home Page with email "OptOut" optionSection 12.3.4 - Updated Figure 37 screenshot to show Example Scenario 1 - Individual RateResults on 2019 Rates template v.8.1Section 12.3.4 - Updated Figure 39 screenshot to show Example Scenario 2 - Individual RateResults on on 2019 Rates template v.8.1Section 12.3.4 - Updated Figure 41 to show Example Scenario 3 - Individual and Group RateResults on the 2019 Rates Template v8.1RBIS User Manual – Last Updated August 2020Page ix
HIOS RBIS User Manual v 08.00.001IntroductionThe Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Department ofHealth and Human Services (HHS), is charged with helping implement many provisions of the AffordableCare Act. CCIIO oversees the implementation of the provisions related to private health insuranceincluding providing oversight for the Issuer-based data exchanges that populatehttp://www.finder.healthcare.gov and http://www.healthcare.gov.To facilitate this charge, the Health Insurance Oversight System (HIOS) allows the government to collectdata from individual and small group market Issuers. The collected data is aggregated with other datasources and made public on a consumer-facing website. The Rate and Benefits Information System(RBIS) web site gathers detailed plan benefit and eligibility data. This user manual explains the featuresand other aspects related to the use of the RBIS module.1.1Instructional LayoutThe term ‘user’ is used throughout this document to refer to a person who has acquired access tocomplete activities within the RBIS module. Each action that is required by the user is indicated via stepby-step bullets. If an action requires the user to select a specific button or link on the screen, the nameof the item to look for will be in bold italics. For example:1. Select OK.HIOSRBIS User Manual – Last Updated August 20Page 1
HIOS RBIS User Manual v 08.00.002Getting Started2.1Minimum RequirementsSupported ApplicationsThe templates and associated submission materials are provided in the following formats: Plans and Benefits Add-In – .xlam Plan Benefits Template – .xlsm (macro enabled xls worksheet) AV Calculator – .xlsm Service Area Template – .xls Rates Template – .xls Business Rules Template – .xls RBIS URL Template - .xlsThe templates referenced above (with the exception of the RBIS URL template) are the QHP templatesalso used for submission of plan and benefits information to the Federally Facilitated Marketplace(FFM). The templates may be downloaded through RBIS or directly from the QHP website under theApplication Materials tab found at the address cation%20MaterialsThe RBIS module supports either of the following compatible browsers: Internet Explorer Mozilla Firefox2.1.1Macro Security Level SettingThe RBIS Templates use macros to perform the built-in functions including the Validation andFinalization processes. It is imperative that Excel’s macro security level settings are set to allow macros.The following are the Excel macro security level settings: 2.1.2Excel 2013 or later: Macros should be set to “Disable all macros with notification.” Instructionswill be provided in Section 2.1.2.1 : Set-up Considerations.Set-up ConfigurationsConfiguration on the computer must be set to satisfy the following requirements for the data templatesto work properly:HIOS Use Microsoft Excel version 2013 or later Enable the Excel standard toolbarRBIS User Manual – Last Updated August 2020Page 2
HIOS RBIS User Manual v 08.00.002.1.2.1Excel Version 2013 or laterSet the Excel macro security settings as follows:1. For Excel 2013/ latest version, set Excel macro security settings to “Disable all macros withnotifications.”a. Select the File button in the upper left corner of the window.b. Select the Options button at the bottom of the menu.c. Select Trust Center on the left navigation pane.d. Select Trust Center Settings.e. Select Macro Settings on the left navigation pane.f.Select the radio button in front of Disable all macros with notifications.g. Select OK.h. When the workbook is opened, select the Options button and select Enable Contentand select OK.2.2Marketplace Service DeskIf you need assistance with registering as a user, submitting data, reviewing and validating data, or othertechnical website functions, please contact the Marketplace Service Desk (MSD). Phone Number: 1-855-267-1515 Email Address: CMS FEPS@cms.hhs.govThe MSD hours of operation are 9:00 AM to 6:00PM ET, Monday through Friday.2.3User RegistrationIssuers must first be a registered user in HIOS in order to gain access into RBIS. A user can be registeredin HIOS by being added as a contact for an Issuer. If you have questions, please refer to the HIOS userguide or call the MSD. Any access requests outside of the normal HIOS process must be submitted forCCIIO approval via the MSD at 1-855-267-1515 or via email at CCIIOPlanFinder@cms.hhs.gov.2.
Section 7.1 - Updated Figure 11 screenshot with 2021 Plan Benefits template Section 7.1 - Updated Figure 12 screenshot to display invalid data message on 2021 Plan Benefits template Section 7.2 - Updated Figure 14 screenshot with 2021 Service Area template Section 7.3 - Updated Figur
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The commercial health insurance market is the only source of health insurance directly regulated by the Utah Insurance Department, hereafter referred to as the Insurance Department for the purposes of this report. Approximately 44 percent of Utah's commercial health insurance market is comprehensive health insurance (also known as major medical).
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