Plans and Benefits

All issuers are required to provide the following data on their health plans:
  • Plan identifiers
  • Plan attributes
  • URLs
  • Covered benefits and their limits
  • Cost-sharing information
Issuers enter this plan data (except for URLs, which are submitted through the SSM) in the Plans and Benefits Template, which consists of two worksheets: the benefits package worksheet and the cost share variances worksheet.

Issuers must also indicate essential health benefit (EHB) benchmark plan coverage requirements. To reflect these requirements, the Plans and Benefits Add-in file populates state- and market-specific EHB benchmark data in the benefits package worksheet.

Key Changes for PY21: 
  • The EHB benchmark, which is populated through the Refresh EHB button in the Plans & Benefits Add-In, has been updated to reflect plan year changes.
  • Plan URLs are no longer collected in the Plans & Benefits Template. Issuers must now submit their URLs via the Supplemental Submission Module (SSM).
  • The issuer’s tax identification number is no longer required on this template.

Tips for the Plans & Benefits Section

  • Download the most recent versions of the 2021 Plans & Benefits Template, Plans & Benefits Add-In file, and Actuarial Value Calculator (AVC).
  • Save the Plans & Benefits Add-In file in the same folder as the Plans & Benefits Template for the macros to run properly.
  • All data elements that CMS anticipates displaying to individual market consumers on Plan Compare are identified by a number sign (#) next to the field name in the instructions.
  • All data fields required for SADP issuers are identified by an asterisk (*) next to the field name in the instructions. 
  • All data fields used by the AVC are identified by a caret (^) next to the field name in the instructions.
  • Issuers should complete the Network, Service Area, and Prescription Drug Templates (QHPs only) and save the templates before filling out the Plans & Benefits Template. The Plans & Benefits Template requires issuers to assign a network, service area, and formulary ID to each plan based on the IDs already created in these three templates.
  • Complete a separate Benefits Package worksheet for each unique benefits package the issuer wishes to offer. To create additional benefits packages, click the Create New Benefits Package button on the menu bar under the Plans & Benefits Add-In. The HIOS Issuer ID, Issuer State, Market Coverage, and Dental Only Plan fields are auto-populated.
  • Complete a row in the associated Cost Share Variances worksheet for each plan and associated cost-sharing reduction (CSR) plan variation the issuer wishes to offer.
  • The cost sharing entered in the Plans & Benefits Template must reflect what the consumer pays. See the AVC instructions for how these values relate to actuarial value (AV).
  • When a cell is grayed out, it is locked and cannot be edited. HIOS will not process data entered into the cell before it was grayed out.
Application Resources