README.md

Insurer Existence Transparency

This data collects metadata related to U.S. health insurers and the plans they sell. The data is broken down into the following three categories:

1. Insurers

   The file insurers.csv contains metadata related to insurance companies.

2. Issuers

   The file issuers.csv contains metadata related to insurance health plan issuers.

3. Plans

   The file plans.csv contains metadata related to insurance health plans.

We provide some more details on these three files below.

Insurers

Insurance companies are legal entities registered with federal and state governments that sell insurance. Each such entity can sell insurance plans in one or many states.

This file is a flat file with the following schema:

Name	Description	Type	Definition	Required	Example Value
homepage_url	URL	String	a url for the insurers homepage on the web.	No	www.cignahealthspring.com
state_or_regions	State or Regions	Enum(ABBREV) (see below)	State or regions in which legal reporting entity sells insurance. Comma separated list.	Yes	DC,MD
naic_company_code	NAIC insurance company identifier	String	The NAIC insurance company level identifier.	No	10095
insurer_name_legal	Legal name of insurance company.	String	The legal name of the issuer entity.	Yes	bravo health mid atlantic inc
org_street_address	Street Address	String	Street address for organizational mailing address of company.	No	500 GREAT CIRCLE ROAD
org_city	City	String	City for organizational mailing address of company.	No	nashville
org_state_or_region	State or Region	String	State or Region code for organizational mailing address of company.	No	TN
org_zip_code	Zip code	String	Zip code for organizational mailing address of company.	No	21224-5238
org_phone	Phone number	String	Phone number for organizational mailing address of company.	No	800-235-9188
ein	Federal employer Identification Number	String	The IRS employer identification number for the company.	No

Issuers

To quote CMS,

Issuers represent the organization within an insurance company that is responsible for insurance offerings within a given state.

Any health insurance company will have one issuer per state in which they are licensed to do business. Currently, this data is focused on Qualified Health Plans (QHP) as the term is defined by CMS. This is merely a matter of convenience at the moment, since such plans are easier to track via e.g. HIOS identifers. We ultimately want to track all U.S. health plans, whether qualified or not.

This file is a flat file with the following schema:

Name	Description	Type	Definition	Required	Example Value
hios_issuer_id	Health Insurance Oversight System Issuer ID	String	Five-digit int/string (not sure if it can lead with 0s) that identifies the issuer organization as assigned by Health Insurance Oversight System (HIOS).	Yes	91450
insurer_name_legal	Legal name of insurance company.	String	The legal name of the issuer entity.	No	Health Net of Arizona, Inc.
state_or_region	State or Region	Enum(ABBREV) (see below)	State or region in which legal reporting entity is incorporated.	Yes	AZ
serff_id	SERFF issuer identifier	String	The NAIC SERFF defined issuer identifier. To quote CMS, "NAIC maintains a reporting service called SERFF which is used by most states and required by 27 states to track submissions from insurance carriers to state DOI commissioners."	No
naic_company_code	NAIC insurance company identifier	String	The NAIC insurance company level identifier.	No

Plans

Plans refer to particular products sold by issuers that have a well-defined collection of benefits, as well as additional cost sharing rules attached to the products. Specifying a plan should uniquely specify the coordination of benefits, covered services, formulary, issuer, etc., and some aspects of cost sharing. Specifying a product should uniquel specify the coordination of benefits, covered services, formulary, issuer, etc., but not the cost sharing details. The total price payed by a consumer for a given plan will however still depend on details of the consumer, such as exact geographic location, age, and other stats; for example, a given plan typically has different premiums for people of different ages.

To quote CMS,

A product is a discrete package of health insurance coverage benefits that are offered using a particular product network type (such as health maintenance organization, preferred provider organization, exclusive provider organization, point of service, or indemnity) within a service area.

Plans, with respect to a product, are the pairing of the health insurance coverage benefits under the product with a particular cost sharing structure, provider network, and service area that are offered to consumer.

This file is a flat file with the following schema:

Name	Description	Type	Definition	Required	Example Value
hios_issuer_id	Health Insurance Oversight System Issuer ID	String	Five-digit int/string (not sure if it can lead with 0s) that identifies the issuer organization as assigned by Health Insurance Oversight System (HIOS).	Yes	91450
hios_plan_id	Health Insurance Oversight System (HIOS) Rate and Benefits Information System ID for the Plan	String	Fourteen character string that identifies the plan as specified in RBIS, if applicable.	No
plan_name	Marketing name for the plan	String	Name for plan	No
marketplace_type	Marketplace type specifier	Enum("individual", "small group", "large group")	Enum specifying marketplace type on which plan is sold, if applicable.	No
hios_product_id	HIOS product id for the plan.	String	Ten character string that identifies the product in HIOS, if applicable.	No
plan_type	Type of plan.	Enum("hmo", "ppo", "epo", "pos", "dental", "indemnity", "other")	High level type of contract.	No
sob_url	Url for summary of benefits	String	URL for publicly hosted summary of benefits for plan.	No
full_benefits_url	Url for full benefits contract	String	URL for publicly hosted copy of full benefits booklet.	No
plan_metal_level	Metal level of plan	Enum("platinum", "gold", "silver", "bronze", "catastrophic")	Metal level of plan as designated by healthcare.gov	No
effective_date	Date on which plan came into existence	String	Date on which plan came into existence. Date must be in an ISO 8601 format (i.e. YYYY-MM-DD).	No
expiration_date	Date after which plan is invalid	String	Date on which plan came into existence. Date must be in an ISO 8601 format (i.e. YYYY-MM-DD).	No

Note:

Why not store this all in a sql database?

The files below ought to be thought of as tables in a relational schema, and belong most naturally in a relational database. In fact, this is how https://persius.org uses such data behind the scenes in our free tools, and the data here was initially populated as an export of a populated SQL DB. We maintain flat files here with foreign key constraints relaxed to mere implications just to facilitate accessible access (both read, and write) for those who aren't familiar with SQL, but who want to use or contribute to this data. Keeping this data up to date is going to constitute persistent work given current reporting standards, and we want to engender effective collective action.

The state_or_region entry, if entered, must be one of the following ABBREV standardized abbreviation strings:

State or Region	ABBREV
Alabama	AL
Alaska	AK
American Samoa	AS
Arizona	AZ
Arkansas	AR
California	CA
Colorado	CO
Connecticut	CT
Delaware	DE
District of Columbia	DC
Florida	FL
Georgia	GA
Guam	GU
Hawaii	HI
Idaho	ID
Illinois	IL
Indiana	IN
Iowa	IA
Kansas	KS
Kentucky	KY
Louisiana	LA
Maine	ME
Maryland	MD
Massachusetts	MA
Michigan	MI
Minnesota	MN
Mississippi	MS
Missouri	MO
Montana	MT
Nebraska	NE
Nevada	NV
New Hampshire	NH
New Jersey	NJ
New Mexico	NM
New York	NY
North Carolina	NC
North Dakota	ND
Northern Mariana Islands	MP
Ohio	OH
Oklahoma	OK
Oregon	OR
Pennsylvania	PA
Puerto Rico	PR
Rhode Island	RI
South Carolina	SC
South Dakota	SD
Tennessee	TN
Texas	TX
Utah	UT
Vermont	VT
Virgin Islands	VI
Virginia	VA
Washington	WA
West Virginia	WV
Wisconsin	WI
Wyoming	WY