Health Insurance State-based Exchange Public Use Files

Health Insurance State-based Exchange Public Use Files

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is committed to increasing transparency in the Health Insurance Exchange. While health plan information including benefits, copayments, premiums, and geographic coverage is publicly available on the various State-based Exchange (SBE) websites, CMS has also released downloadable public use files (PUF) so researchers and other stakeholders may more easily access SBE data.

State-based Exchanges that use the Federal Platform for Qualified Health Plan (QHP) eligibility and enrollment functions (SBE-FPs) are not included in these files as they are included in the PUF for states on the Federal platform. 

Currently, the SBE QHP PUF are available for the certified QHP plan years (PYs) 2016 through 2024. SBE QHP PUF for each plan year are published as of the dates indicated in the individual files. The data will not be updated during the plan year. 

The SBE QHP PUF include plan and issuer level information for certified (QHPs) and stand-alone dental plans (SADPs) offered to individuals and small businesses through the State-based Exchanges. The SBE QHP PUF do not contain enrollment or claims data.  SHOP data are included for SBEs and SBE-FPs that have participating SHOP issuers. The data provided in the SBE QHP PUF were received from the National Association of Insurance Commissioners (NAIC), which extracted the data from their System for Electronic Rate and Form Filing (SERFF). Only data available through the SERFF were included in the SBE QHP PUF. The SBE states were provided an opportunity to review and verify the data prior to publication. 

The SBE QHP PUF consists of six separate files as described here for each of the SBE states. To access and download the SBE QHP PUF for each state and plan year, select the associated link in the "Downloads" section below. The data dictionary for each PY and SBE QHP PUF is available with corresponding PY.

  • Benefits and Cost Sharing PUF (BenCS-PUF) – Plan-level data on essential health benefits, coverage limits, and cost sharing.
  • Rate PUF (Rate-PUF) – Plan-level data on individual rates based on an eligible subscriber’s age, tobacco use, and geographic location.
  • Plan Attributes PUF (Plan-PUF) – Plan-level data on maximum out of pocket payments, deductibles, cost sharing, Health Savings Account (HSA) eligibility, formulary ID, and other plan attributes.
  • Business Rules PUF (BR-PUF) – Plan-level data on the application of rates, such as allowed relationships (e.g., spouse, dependents), and tobacco use.
  • Service Area PUF (SA-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 (Ntwrk-PUF) – Issuer-level data identifying provider network URLs.

For more information about the SBE QHP PUF, please review the General Information Factsheet, Frequently Asked Questions, Data Disclaimer-User Agreement, and Data Dictionaries. For any further inquiries, please contact CMS at SBE_PublicUseFiles@cms.hhs.gov.

Downloads

2024 SBE QHP PUF Datasets (Data current as of May, 14, 2024)

2024-SBE-QHP-PUF-DataDictionary (ZIP)

2023 SBE QHP PUF Datasets (Data current as of May, 17, 2023)

2023-SBE-QHP-PUF-Data-Dictionary (ZIP)

2022 SBE QHP PUF Datasets (Data current as of July 29, 2022)

2022-SBE-QHP-PUF-Data-Dictionary (ZIP)

2021 SBE QHP PUF Datasets (Data current as of August 2021)

2021-SBE-QHP-Data-Dictionary (ZIP)

2020 SBE QHP PUF Datasets (Data current as of August 2021)

2020-SBE-QHP-PUF-Data-Dictionary (ZIP)

2019 SBE QHP PUF Datasets (Data current as of August 2019; data updates were made in August 2021 and documented in the PY2019-SBE-QHP-Public-Use-Files-Changes (PDF)

2019-SBE-QHP-PUF-Data-Dictionary (PDF) (ZIP)

2018 SBE QHP PUF Datasets (Data current as of June 2017)

2018-SBE-QHP-PUF-Data-Dictionary (ZIP)

2018-SBE-QHP-PUF-User-Notes (PDF)

2017 SBE QHP PUF Datasets (Data current as of 20 December 2016; for DC and MA as of January 2017)

2017 SBE-QHP-PUF-Data-Dictionary (ZIP)

Kentucky and Nevada transitioned to the Federal Exchange for 2017 and their public use files may be found on the Health Insurance Exchange PUF CCIIO website, which includes the Federal Exchange PUF files.

2016 SBE QHP PUF Datasets ( Data current as of February 2016)

2016-SBE-QHP-PUF-Data-Dictionary (ZIP)

      Note: The PY 2016 Business Rules PUF is not available for Arkansas

Page Last Modified:
09/10/2024 06:23 PM
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