Today, in an effort to facilitate greater access to Marketplace data, CMS released a set of state-based Marketplace public use files (SBM PUF). Each file contains data associated with certified qualified health plans (QHPs) and stand-alone dental plans (SADPs) within state-operated Marketplaces.

 

While health plan information including benefits, copayments, premiums, and geographic coverage is publically available on HealthCare.gov, these downloadable files on the other hand, will help researchers and other stakeholders conduct timely benefit and rate analysis.

 

With that, the SBM PUF is comprised of the following 2016 Data Dictionaries:

• Benefits and Cost Sharing PUF  – Plan-level data on essential health benefits, coverage limits, and cost sharing.
• Rate PUF  – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
• Plan Attributes PUF  – Plan-level data on maximum out of pocket payments, deductibles, cost sharing, HSA eligibility, formulary ID, and other plan attributes.
• Business Rules PUF  – Additional information on how an issuer determines the premiums for a specific application.  For example: the maximum number of dependents used to determine a family rate for single or two parent families, the maximum age for a dependent, whether a domestic or same sex partner may be treated as a spouse, Number of tobacco-free months considered when qualifying for a non-tobacco rate.
• Service Area 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 – Issuer-level data identifying provider network URLs.

To download the files, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/sbm-puf.html