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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