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Actuarial Value

ME120, Utah



Name:Actuarial Value
Data Element ID:ME120
Description:Report value as calculated in the most recent version of the HHS Actuarial Value Calculator available at http://cciio.cms.gov/resources/regulations/index.html Size includes decimal point. Required as of January 1, 2014 for small group and non-group (individual) plans sold inside or outside the Exchange.
State:Utah
Data Type:decimal
Length:6
Required:R for plans where ME 106 = A or B; otherwise Optional
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File Specification for Multiple versionsMedical Eligibility File Submission - December 5, 2013 - v2.0

Data Element ID Data Element Description Type Format Length
ME001 Payer Code Distributed by OHCS varchar 8
ME002 Payer Name Distributed by OHCS varchar 30
ME003 Insurance Type Code/Product Not Provided char 2
ME004 Year 4 digit Year for which eligibility is reported in this submission int 4
ME005 Month Month for which eligibility is reported in this submission expressed numerical from 01 to 12. char 2
ME006 Insured Group or Policy Number Group or policy number - not the number that uniquely identifies the subscriber varchar 30
ME007 Coverage Level Code Benefit coverage level char 3
ME008 Subscriber Social Security Number Subscriber's social security number; Set as blank if unavailable varchar 9
ME009 Plan Specific Contract Number Plan assigned subscriber's contract number; Set as null if contract number = subscriber's social security number or use an alternate unique identifier such as Medicaid ID. Must be an identifier that is unique to the subscriber. varchar 128
ME010 Member Suffix or Sequence Number Unique number of the member. This column is the unique identifying column for membership and related medical and pharmacy claims. Only one record per eligibility month. Must match MC009 and PC009. varchar 128
ME011 Member Identification Code Member's social security number; Set as blank if unavailable. varchar 9
ME012 Individual Relationship Code Member's relationship to insured char 2
ME013 Member Gender Not Provided char 1
ME014 Member Date of Birth Not Provided char YYYYMMDD 8
ME015 Member City Name City location of member varchar 30
ME016 Member State or Province As defined by the US Postal Service char 2
ME017 Member ZIP Code ZIP Code of member - may include non-US codes. Do not include dash. Plus 4 optional but desired. varchar 11
ME018 Medical Coverage Not Provided char 1
ME019 Prescription Drug Coverage Not Provided char 1
ME020 Dental Coverage Not Provided char 1
ME021 Race 1 Not Provided varchar 6
ME022 Race 2 Not Provided varchar 6
ME023 Other Race List race if MC021or MC022 are coded as R9. varchar 15
ME024 Hispanic Indicator Not Provided char 1
ME025 Ethnicity 1 Not Provided varchar 6
ME026 Ethnicity 2 Not Provided varchar 6
ME027 Other Ethnicity List ethnicity if MC025 or MC026 are coded as OTHER. varchar 20
ME028 Primary Insurance Indicator Not Provided char 1
ME029 Coverage Type Not Provided char 3
ME030 Market Category Code Not Provided varchar 4
ME032 Group Name Group name or IND for individual policies varchar 128
ME043 Member Street Address Street address of member varchar 50
ME044 Employer Name Name of the Employer, or if same as Group Name, null varchar 50
ME101 Subscriber Last Name The subscriber last name varchar 128
ME102 Subscriber First Name The subscriber first name varchar 128
ME103 Subscriber Middle Initial The subscriber middle initial char 1
ME104 Member Last Name The member last name varchar 128
ME105 Member First Name The member first name varchar 128
ME897 Plan Effective Date Date eligibility started for this member under this plan type. The purpose of this data element is to maintain eligibility span for each member. char YYYYMMDD 8
ME045 Exchange Offering Identifies whether or not a policy was purchased through the Utah Health Benefits Exchange (UBHE). char 1
ME106 Group Size Code indicating Group Size consistent with Utah Insurance Law and Regulation Required only for plans sold in the commercial large, small and non-group markets. The following plan/products do not need to report this value: Student plans Medicare supplemental Medicaid-funded plans Stand-alone behavioral health, dental and vision char 2
ME107 Risk Basis Not Provided char 1
ME108 High Deductible/ Health Savings Account Plan Not Provided char 1
ME120 Actuarial Value Report value as calculated in the most recent version of the HHS Actuarial Value Calculator available at http://cciio.cms.gov/resources/regulations/index.html Size includes decimal point. Required as of January 1, 2014 for small group and non-group (individual) plans sold inside or outside the Exchange. decimal 6
ME121 Metallic Value Metal Level (percentage of Actuarial Value) per federal regulations. Required as of January 1, 2014 for small group and non group (individual) plans sold inside or outside the Exchange. Use values provided in the most recent version of the HHS Actuarial Value Calculator available at : http://cciio.cms.gov/resources/regulations/index.html int 1
ME122 Grandfather Status See definition of "grandfathered plans" in HHS rules CFR 147.140 Required as of January 1, 2014 for small group and non group (individual) plans sold inside or outside the Exchange. Char 1
ME899 Record Type Not Provided char 2

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