{"text_format":"1","workbook":"xlsx","n_sheets":61,"sheets":["Transmittal","Main Data","Limited Data","Stop Loss Data","Notes","Data Reconciliation",">Instructions begin","Technical Troubleshooting","Introduction","Tabulation Methods & Issues","Coverage Type","Plan Type","Market Category","Geographic Location","St, Fed, Muni, HK","Qualified Assoc Trust","Prof Employer Org","HealthFirst","Calendar Year","Policyholder Months","Subscriber Months","Member Months","Total Premium","Claims Columns","Plan ID","Plan Code","Policy Form Number","Exchange Indicator","Grandfathered Indicator","HDHP","Open","New","Ded_Med","Ded_Pharm","Prevent Svcs","MHSA","Tiered Network","Copays","Deductible","Coinsurance","OOP Max","Pharmacy Deductibles","Pharmacy Copays","Actuarial Value","Exception Variables","Specific Premium","Specific Claims","Specific Attachment Point","Specific % Reimbursable","Specific Reimbursement Max","Aggregate Premium","Aggregate Claims","Aggregate Attachment Point","Aggregate % Reimbursable","Aggregate Reimbursement Max","Medical","Pharmacy","Dental","Vision","Disability","Instructions End>"],"not_rendered":{"charts":0,"images":11,"macros":1,"external_links":1,"defined_names":123,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Transmittal","index":0,"n_rows":50,"n_cols":16,"rows_kept":50,"cut":false,"hidden":false,"merged":[[2,13,8,18],[9,13,15,18],[23,13,23,18],[29,13,29,18],[10,1,10,6],[5,1,5,6],[6,1,6,6],[7,1,7,6],[8,1,8,6],[9,1,9,6],[11,1,11,6],[12,1,12,6],[13,1,13,6],[14,1,14,6],[15,1,15,6],[0,0,0,6],[1,1,1,6],[2,1,2,6],[3,1,3,6],[4,1,4,6],[27,0,28,0],[29,1,29,6],[29,7,29,12],[23,7,23,12],[30,0,32,0],[24,0,25,0],[23,1,23,6]]}
["Enter Data in the shaded areas only"]
["Field Name","Data Entry",null,null,null,null,null,"Field Name",null,null,null,null,null,"Data Entry"]
["Company Code",null,null,null,null,null,null,"Identify all subcontractors and the services that are"]
["Company Name",null,null,null,null,null,null,"subcontracted (e.g. prescription drugs, mental health/"]
["Reporting Year",null,null,null,null,null,null,"substance abuse)."]
["Date Fiscal Year Ends"]
["Contact Person Information"]
["  First Name"]
["  Last Name"]
["  Mailing Address Line 1",null,null,null,null,null,null,"Are all claims for subcontracted services included in the "]
["  Mailing Address Line 2",null,null,null,null,null,null,"submitted data?"]
["  Mailing Address City"]
["  Mailing Address 2-Letter State Abbreviation",null,null,null,null,null,null,"Input “Y” for yes, “N” for no."]
["  Mailing Zip Code",null,null,null,null,null,null,"If “N” please explain what has been included and/or excluded."]
["  Voice Phone Number"]
["  e-mail Address"]
[]
[]
["When Data Entry is Complete Please Run the Data Validation Process."]
["Identified Cells with Potential Errors Have Been Highlighted"]
[" Please Check These and Make Any Necessary Corrections Before Submitting."]
[]
[]
[null,"Main Data Tab",null,null,null,null,null,"Limited Data Tab",null,null,null,null,null,"Stop Loss Data Tab"]
["Total Possible Value Errors","There are",0,"Null Cells that May Need to be Corrected",null,null,null,"There are",0,"Null Cells that May Need to be Corrected",null,null,null,"There are",0,"Null Cells that May Need to be Corrected"]
[null,"There are",0,"Invalid Cells that May Need to be Corrected",null,null,null,"There are",0,"Invalid Cells that May Need to be Corrected",null,null,null,"There are",0,"Invalid Cells that May Need to be Corrected"]
[]
[]
[]
[null,"Main Data Tab",null,null,null,null,null,"Limited Data Tab",null,null,null,null,null,"Stop Loss Data Tab"]
["Value Errors - Please Review and Correct","There are",0,"Coverage Codes that Need to be Corrected",null,null,null,"There are",0,"Coverage Codes that Need to be Corrected",null,null,null,"There are",0,"Coverage Codes that Need to be Corrected"]
[null,"There are",0,"Plan Codes that Need to be Corrected",null,null,null,"There are",0,"Plan Codes that Need to be Corrected",null,null,null,"There are",0,"Plan Codes that Need to be Corrected"]
[null,"There are",0,"Market Codes that Need to be Corrected",null,null,null,"There are",0,"Market Codes that Need to be Corrected",null,null,null,"There are",0,"Market Codes that Need to be Corrected"]
[]
["Geographic Inconsistency - Please Review and Correct*","There are",0,"Codes that Need Review - Highlighted in Yellow",null,null,null,"There are",0,"Codes that Need Review - Highlighted in Yellow"]
[]
["Coinsurance Inconsistency - Please Review**","There are",0,"Codes that Need Review - Highlighted in Yellow"]
[]
["Actuarial Value Inconsistency - Please Review***","There are",0,"Codes that Need Review - Highlighted in Yellow"]
[]
["Deductible Inconsistency - Please Review and Correct****","There are",0,"Codes that Need Review - Highlighted in Yellow"]
[]
["Out of Pocket Max Inconsistency - Please Review and Correct*****","There are",0,"Codes that Need Review - Highlighted in Yellow"]
[]
[]
["* Main Data Tab Cannot have 'Y' as a Geographic Segment"]
["** Member Coinsurance is typically not over 50% - Please Review"]
["*** AV is typically not over 1.00 - Please Review"]
["**** Deductible for HDHP is limited to a minimum of $1200 by the IRS - Please Review"]
["***** Out of Pocket Maximum for HDHP is limited to a maximum of $6050 by the IRS - Please review"]

{"sheet":"Main Data","index":1,"n_rows":1,"n_cols":74,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Coverage Type","Plan Type","Market Category Code","Policyholder Geographic Location","State, Federal, Municipal or Healthy Kids Account","Qualified Association Trust","Professional Employer Organization","HealthFirst","Calendar Year","Number of Policyholder Months","Number of Subscriber Months","Number of Member Months","Total Premium","Total Claims","Claims Incurred and Paid","Claims Incurred and Unpaid","Other Payments and Credits","Member Responsibility","Plan ID","Plan Code","Policy Form Number","Exchange Indicator","Grandfathered Indicator","HDHP","Is this health coverage plan open?","Is this a new health coverage plan?","Does  Deductible apply to all Medical Services?","Does  Deductible apply to Pharmacy Services?","Are Preventive Services Covered 100%?","Does this health coverage plan provide for coverage for MH/SA?","Does this health coverage plan have a Tiered Network component?","PCP Office Visit Copay","Specialist Office Visit Copay","ED Copay","Outpatient Surgery Copay","Inpatient Copay","In-Network Single Deductible","In-Network Coinsurance","In-Network Single OOP Max","Retail Pharmacy Single Deductible Generic","Retail Pharmacy Single Deductible Brand Formulary","Retail Pharmacy Single Deductible Brand Non-Formulary","Reatil Pharmacy Copay Generic","Retail Pharmacy Copay Brand Formulary","Retail Pharmacy Copay Brand Non-Formulary","Actuarial Value","Ambulance Service","Audiology Screening for Newborns","Blood and Blood Products","Case Management Program","Chiropractic Services","DME","Emergency Room","Family Planning Services","Habilitative Services","Hearing Aids","Home Health Care","Hospice","Hospitalization","Infertility Services","Medical Food","Mental Health and Substance Abuse","Nutritional Services","Outpatient Hospital Services and Surgery","Outpatient Laboratory and Diagnostic Services","Outpatient Short-Term Rehabilitative Services","Pediatric Dental Services","Pediatric Vision Services","Pregnancy and Maternity","Rx","Preventive Services","Skilled Nursing Facility","Transplants","Well Child and Immunization Benefits"]

{"sheet":"Limited Data","index":2,"n_rows":1,"n_cols":17,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Coverage Type","Plan Type","Market Category Code","Policyholder Geographic Location","Qualified Association Trust","Professional Employer Organization","HealthFirst","State, Federal, Municipal or Healthy Kids Account","Number of Policyholder Months","Number of Subscriber Months","Number of Member Months","Calendar Year","Total Claims","Claims Incurred and Paid","Claims Incurred and Unpaid","Other Payments and Credits","Member Responsibility"]

{"sheet":"Stop Loss Data","index":3,"n_rows":1,"n_cols":26,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Coverage Type","Plan Type","Market Category Code","Policyholder Geographic Location","Qualified Association Trust","Professional Employer Organization","State, Federal, Municipal or Healthy Kids Account","Number of Policyholder Months","Number of Subscriber Months","Number of Member Months","Calendar Year","Specific Premium","Specific Claims","Specific Attachment Point","Specific % Reimbursable","Specific Reimbursement Maximum","Aggregate Premium","Aggregate Claims","Aggregate Attachment Point","Aggregate % Reimbursable","Aggregate Reimbursement Maximum","Medical","Pharmacy","Dental","Vision","Disability"]

{"sheet":"Notes","index":4,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Data Reconciliation","index":5,"n_rows":53,"n_cols":12,"rows_kept":53,"cut":false,"hidden":false,"merged":[[2,4,3,4],[3,1,3,2],[2,1,2,2]]}
[]
[]
[null,"Note that the values from the Supplemental Report data in the exhibits below will be automatically populated by clicking the Button on the Transmittal tab."]
[null,"The values from the Supplemental Report data can also be refreshed by clicking the button to the right."]
[]
[]
[null,"Comparison of Supplemental Report Data to NAIC Supplemental Health Care Exhibit"]
[null,"Supplemental Report data is summarized from \"Main Data\" submission based on the criteria listed."]
[null,"Carriers/TPA's must input data reported in NAIC Supplemental Health Care Exhibit for the same reporting year for New Hampshire as referenced in tables below."]
[null,"Differences between the data in the two sources are anticipated in some cases due to the timing differences of data collection and possible categorization differences."]
[null,"Please detail any necessary adjustments to the SHCE values to properly line up with the Supplemental Report values. For example, if SHCE contains data on a block of business that is not included in the Supplemental Report, input the amount as a negative in the Value column and a description in the Description column."]
[null,"If Supplemental Report data varies from the (adjusted) Supplemental Health Care Exhibit data by more than the stated tolerance in either direction, carrier/TPA must provide explanation of difference."]
[]
[null,"Member Months","Supplemental Report",null,"Supplemental Health Care Exhibit",null,"Adjustments to SHCE Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",0,"Part 1 Other Indicators, Line 4 Member Months, Individual",null,null,null,{"$f":"+D16-(F16+H16)","v":0},{"$f":"IF(AND((F16+H16)=0,D16=0),0,IF((F16+H16)=0,1,I16/(F16+H16)))","v":0},0.01]
[null,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",0,"Part 1 Other Indicators, Line 4 Member Months, Small Group",null,null,null,{"$f":"+D17-(F17+H17)","v":0},{"$f":"IF(AND((F17+H17)=0,D17=0),0,IF((F17+H17)=0,1,I17/(F17+H17)))","v":0},0.01]
[null,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",0,"Part 1 Other Indicators, Line 4 Member Months, Large Group",null,null,null,{"$f":"+D18-(F18+H18)","v":0},{"$f":"IF(AND((F18+H18)=0,D18=0),0,IF((F18+H18)=0,1,I18/(F18+H18)))","v":0},0.01]
[null,"Self-Insured","\"Main Data\", where Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",0,"Part 1 Other Indicators, Line 4 Member Months, Uninsured Plans",null,null,null,{"$f":"+D19-(F19+H19)","v":0},{"$f":"IF(AND((F19+H19)=0,D19=0),0,IF((F19+H19)=0,1,I19/(F19+H19)))","v":0},0.01]
[]
[null,"Total Premium","Supplemental Report",null,"Supplemental Health Care Exhibit",null,"Adjustments to SHCE Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",0,"Part 1, Line 1.1 Health premiums earned, Individual",null,null,null,{"$f":"+D23-(F23+H23)","v":0},{"$f":"IF(AND((F23+H23)=0,D23=0),0,IF((F23+H23)=0,1,I23/(F23+H23)))","v":0},0.01]
[null,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",0,"Part 1, Line 1.1 Health premiums earned, Small Group",null,null,null,{"$f":"+D24-(F24+H24)","v":0},{"$f":"IF(AND((F24+H24)=0,D24=0),0,IF((F24+H24)=0,1,I24/(F24+H24)))","v":0},0.01]
[null,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",0,"Part 1, Line 1.1 Health premiums earned, Large Group",null,null,null,{"$f":"+D25-(F25+H25)","v":0},{"$f":"IF(AND((F25+H25)=0,D25=0),0,IF((F25+H25)=0,1,I25/(F25+H25)))","v":0},0.01]
[]
[null,"Total Claims","Supplemental Report",null,"Supplemental Health Care Exhibit",null,"Adjustments to SHCE Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",0,"Part 1, Line 5 Total incurred claims, Individual",null,null,null,{"$f":"+D29-(F29+H29)","v":0},{"$f":"IF(AND((F29+H29)=0,D29=0),0,IF((F29+H29)=0,1,I29/(F29+H29)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",0,"Part 1, Line 5 Total incurred claims, Small Group",null,null,null,{"$f":"+D30-(F30+H30)","v":0},{"$f":"IF(AND((F30+H30)=0,D30=0),0,IF((F30+H30)=0,1,I30/(F30+H30)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",0,"Part 1, Line 5 Total incurred claims, Large Group",null,null,null,{"$f":"+D31-(F31+H31)","v":0},{"$f":"IF(AND((F31+H31)=0,D31=0),0,IF((F31+H31)=0,1,I31/(F31+H31)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[]
[]
[null,"Comparison of Supplemental Report Data to NH CHIS Data"]
[null,"Supplemental Report data is summarized from \"Main Data\" and \"Limited Data\" submissions based on the criteria listed."]
[null,"Carriers/TPA's must input data totals based on data submitted to NH CHIS for the same reporting year as referenced in tables below."]
[null,"Differences between the data in the two sources are anticipated in some cases due to the timing differences of data collection."]
[null,"Please detail any necessary adjustments to the CHIS values to properly line up with the Supplemental Report values."]
[null,"If Supplemental Report data varies from the CHIS data by more than the stated tolerance in either direction, carrier/TPA must provide explanation of difference."]
[]
[null,"Member Months","Supplemental Report",null,"NH CHIS Data Submission",null,"Adjustments to CHIS Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",0,"where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"IND\", \"FCH\", \"GCV\")",null,null,null,{"$f":"+D43-(F43+H43)","v":0},{"$f":"IF(AND((F43+H43)=0,D43=0),0,IF((F43+H43)=0,1,I43/(F43+H43)))","v":0},0.01]
[null,"Small Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",0,"where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GSA\")",null,null,null,{"$f":"+D44-(F44+H44)","v":0},{"$f":"IF(AND((F44+H44)=0,D44=0),0,IF((F44+H44)=0,1,I44/(F44+H44)))","v":0},0.01]
[null,"Large Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",0,"where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"GLG1\", \"GLG2\")",null,null,null,{"$f":"+D45-(F45+H45)","v":0},{"$f":"IF(AND((F45+H45)=0,D45=0),0,IF((F45+H45)=0,1,I45/(F45+H45)))","v":0},0.01]
[null,"Self-Insured","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",0,"where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) in (\"ASW\", \"ASO\"), Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\")",null,null,null,{"$f":"+D46-(F46+H46)","v":0},{"$f":"IF(AND((F46+H46)=0,D46=0),0,IF((F46+H46)=0,1,I46/(F46+H46)))","v":0},0.01]
[]
[null,"Claims Incurred and Paid","Supplemental Report",null,"NH CHIS Data Submission",null,"Adjustments to CHIS Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",0,"Total medical and pharmacy paid claims for members where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"IND\", \"FCH\", \"GCV\")",null,null,null,{"$f":"+D50-(F50+H50)","v":0},{"$f":"IF(AND((F50+H50)=0,D50=0),0,IF((F50+H50)=0,1,I50/(F50+H50)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Small Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",0,"Total medical and pharmacy paid claims for members where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GSA\")",null,null,null,{"$f":"+D51-(F51+H51)","v":0},{"$f":"IF(AND((F51+H51)=0,D51=0),0,IF((F51+H51)=0,1,I51/(F51+H51)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Large Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",0,"Total medical and pharmacy paid claims for members where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) = \"UND\", Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\"), and Market Category (ME030) in (\"GLG1\", \"GLG2\")",null,null,null,{"$f":"+D52-(F52+H52)","v":0},{"$f":"IF(AND((F52+H52)=0,D52=0),0,IF((F52+H52)=0,1,I52/(F52+H52)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Self-Insured","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",0,"Total medical and pharmacy paid claims for members where Medical Coverage (ME018) = \"Y\", member age less than 65, Coverage Type (ME029) in (\"ASW\", \"ASO\"), Insurance Type Code/Product (ME003) in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\")",null,null,null,{"$f":"+D53-(F53+H53)","v":0},{"$f":"IF(AND((F53+H53)=0,D53=0),0,IF((F53+H53)=0,1,I53/(F53+H53)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]

{"sheet":">Instructions begin","index":6,"n_rows":3,"n_cols":2,"rows_kept":3,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,"This tab was intentionally left blank.  Instructions begin on the next tab."]

{"sheet":"Technical Troubleshooting","index":7,"n_rows":62,"n_cols":3,"rows_kept":62,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,"Technical Troubleshooting"]
[null,"Issue - Macro will not run or generates and error message:"]
[null,"If the Data Validation Macro does not run correctly please follow these steps:"]
[]
[null,"1.","Check the data on the 'Main Data', 'Limited Data', and 'Stop Loss Data' tabs for potential issues."]
[null,null,"If possible, run data on one tab at a time to determine which set may potentially have"]
[null,null,"and issue."]
[]
[null,"2a.","If you receive this error, make sure Macros are ENABLED in the workbook."]
[]
[]
[]
[]
[]
[]
[null,"2b.","First, if this displays under the 'Ribbon'"]
[]
[null,"2c.","Click on 'Options' and select 'Enable this Content' and hit 'OK'."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"3a.","If you do not see this dialog, Macros may be disabled already. If this is the case, select the 'Wheel'"]
[]
[null,"3b.","And select 'Excel Options' from the Menu."]
[]
[null,"3c.","Select 'Trust Center'"]
[]
[null,"3d.","And click on 'Trust Center Settings'"]
[]
[null,"3e.","Go to 'Macro Settings'"]
[]
[null,"3f.","And 'Enable All Macros' - Note, this could potentially cause unsafe behavior."]
[]
[null,"3g.","If you are unsure of this option, select 'Disable all macros with notification'"]
[]
[null,"3h.","Then select 'OK' and exit back to the Workbook."]
[]
[null,"3i.","If you selected 'Disable all macros with notification', you may need to restart the workbook and "]
[null,null,"refer back to step 2b."]
[]
[null,"4.","If you still are experiencing issued with the macro, please contact Tyler Brennan at Tyler.Brannen@ins.nh.gov"]

{"sheet":"Introduction","index":8,"n_rows":104,"n_cols":4,"rows_kept":104,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,null,"The State of New Hampshire Insurance Department Supplemental Report Instructions"]
[null,null,"This document provides an overview for the correct way to submit carrier data to the NHID for the 2012 Supplemental Report"]
[null,null,"for the main data, limited data, and stop loss data collection worksheets called \"Main Data,\" \"Limited Data,\" and \"Stop Loss Data.\" "]
[null,null,"Instructions for other portions of the Supplemental Report can be found on the NHID's website in the document, \"The State of New "]
[null,null,"Hampshire Insurance Department Bulletin Docket No.: INS No. 14-005-AB\", dated February 7, 2014."]
[]
[null,null,"The Main Data Collection"]
[null,null,"The main data collection worksheet shall be called ‘”Main Data,” and shall include data for policies with a NH situs with the exception"]
[null,null,"of those with coverage type \"STL.\"   The first row of the Main Data worksheet shall contain the required data fields.  "]
[null,null,"Subsequent rows shall contain the data prescribed.  The data must be provided at the most specific level"]
[null,null,"in order to accurately recognize the health plan product characteristics and benefit differences, including those "]
[null,null,"based on member/patient liabilities.  "]
[]
[null,null,"All numeric data, such as member months and dollar totals, must be reported on an accrual basis in a number format.  Dates of"]
[null,null,"coverage, premium collected, claims paid, and all determinations are based on a calendar year.  Since determinations are "]
[null,null,"made based on the calendar year, the data will include any changes in enrolled membership, premiums, and claims, such as "]
[null,null,"when a group renews mid-year. Data specific to individual groups will be summarized and combined with all other groups with"]
[null,null,"similar benefit characteristics (as determined by the variables in the \"Main Data\" worksheet)."]
[]
[null,null,"The Limited Data Collection"]
[null,null,"The limited data collection worksheet shall be called ‘”Limited Data” and shall include data for policies with a non-NH situs with "]
[null,null,"the exception of those with coverage type \"STL\".   The first row of the Limited Data worksheet shall contain the required data fields. "]
[null,null,"Subsequent rows shall contain the data prescribed.  The data must be provided at the most specific level in order to accurately recognize"]
[null,null,"the health plan product characteristics.  "]
[]
[null,null,"All numeric data, such as member months and dollar totals, must be reported on an accrual basis in a number format.  Dates"]
[null,null,"of coverage, claims paid, and all determinations are based on a calendar year.  Since determinations are made based on the"]
[null,null,"calendar year, the data will include any changes in enrolled membership, premiums, and claims, such as when a group renews"]
[null,null,"mid-year. Data specific to individual groups will be summarized and combined with all other groups with similar characteristics"]
[null,null,"(as determined by the variables in the \"Limited Data\" worksheet)."]
[]
[null,null,"Stop Loss Data Collection"]
[null,null,"The stop loss data collection worksheet shall be called “Stop Loss Data” and shall include all data related to “STL” coverage type "]
[null,null,"(both NH and non-NH situs).   The first row of the Stop Loss Data worksheet shall contain the labels listed in the Variable column below. "]
[null,null," Subsequent rows shall contain the data prescribed.  The data must be provided at the most specific level in order to accurately recognize"]
[null,null," the product characteristics."]
[]
[null,null,"All numeric data, such as member months and dollar totals must be reported on an accrual basis in a number format.  Dates of coverage, "]
[null,null,"claims paid, and all determinations are based on a calendar year.  Since determinations are made based on the calendar year, the data "]
[null,null,"will include any changes in enrolled membership, premiums, and claims, such as when a group renews mid-year. Data specific to individual "]
[null,null,"groups will be summarized and combined with all other groups with similar characteristics (as determined by the variables in the \"Stop Loss "]
[null,null,"Data\" worksheet).  "]
[]
[null,null,"This Instruction section of the file identifies the following:"]
[null,null,"-","Instructions on how to calculate and enter each field in the Supplemental Report Template;"]
[null,null,"-","Examples of correct data entries and formats for each field;"]
[]
[]
[null,"-","This document is meant to be a quick reference document for carriers as they prepare their data for the NHID's Supplemental Report."]
[null,"-","Instructions for each field can be found in in separate tabs in this document in the order in which they appear in the Supplemental Report Template."]
[null,null,"All descriptions and definitions referenced in this report are from \"The State of New Hamphire Insurance Department Bulletin Docket No.: "]
[null,null,"INS No. 14-005-AB,\" dated February 7, 2014."]
[]
[null,null,"Changes in Requirements"]
[null,null,"The following is a high-level description of changes made to the bulletin from the previous bulletin. Do not rely on this list exclusively; read the entire"]
[null,null,"bulletin to ensure compliance with reporting requirements."]
[]
[null,"-","Two additional questions are included on the \"Transmittal\" sheet. Previously, these questions had been asked following the initial data submission."]
[null,"-","Data will now be reported in three separate data collections: (1) the Main Data Collection for policies with a NH situs, (2) the Limited Data"]
[null,null,"Collection for policies without a NH situs, and (3) the Stop Loss Data Collection for policies with Coverage Type Code = \"STL\".  Descriptions "]
[null,null,"of the three data collections are found below in the “Tabulation Methods and Issues” section and separate report specifications have been provided"]
[null,null,"for each in Attachment A."]
[null,"-","Since there is now a separate data collection for Stop Loss, additional data elements specific to stop loss coverage will now be reported. These data"]
[null,null,"elements are described in Attachment A for the Stop Loss Data collection."]
[null,"-","The calculation of the Actuarial value reported in the Supplemental Report has changed. Refer to the Definitions section and Attachment A for the updated methodology."]
[null,"-","Additional identifiers and benefit design components will now be reported. These additional data elements are described in Attachment A for the Main Data Collection."]
[null,"-","Two new Exception Variables have been added to the list of Exception Variables in the Main Data Collection. See Attachment A for descriptions."]
[null,"-","Modifications have been made to descriptions for the following Exception Variables: Family Planning Services, Infertility Services, Hearing Aids, and Preventive Services. "]
[null,null,"Refer to Attachment A for revised descriptions."]
[null,"-","A new code, \"DM\", has been added to the Exception Variables. This new code is to be used when the insurance policy generally covers the service, but does not "]
[null,null,"meet the exact specification in the service description."]
[null,"-","Additional clarification around the reporting of Stop Loss coverage has been provided to ensure that all carriers/TPA’s are reporting when applicable."]
[]
[null,null,"Purpose of Changes"]
[null,null,"A special, one-time data collection of 2012 data for the Supplemental Report is necessary to set a baseline for the data with the new requirements for the data structure "]
[null,null,"and data elements. This will allow for consistent year-to-year comparisons to the 2013 data for the 2013 Supplemental Report.  As the New Hampshire health insurance market "]
[null,null,"changes due to external forces such as the Affordable Care Act, the new requirements should provide additional insight into the market as a whole.  By separating the "]
[null,null,"Stop Loss data into its own collection and including data elements specific to Stop Loss coverage, the Supplemental Report will be able to include more relevant "]
[null,null,"detail around this product each year.  The Actuarial Value methodology was changed in an effort to make it easier to compare the relative benefit richness across "]
[null,null,"market segments and products and how this changes over time.  Additional data elements have been added to the Supplemental Report in an effort to create "]
[null,null,"consistency across various reporting processes and to allow for monitoring the impacts of the Affordable Care Act on the New Hampshire market."]
[]
[null,null,"Due Date"]
[null,null,"Carriers and TPAs are required to submit an annual supplemental report on or before July 15th of each year summarizing the carrier’s business "]
[null,null,"from the immediately preceding calendar year. For example, the data submission due July 15, 2014, shall summarize the carrier’s business for the preceding"]
[null,null,"calendar year, ending on December 31, 2013."]
[]
[null,null,"A special, one time supplemental report will be required to be submitted by March 15, 2014 for the 2012 reporting year to support changes"]
[null,null,"in the data being requested. The two reports due in 2014 are necessary due to the analysis of changes from one year to the next that is performed within the "]
[null,null,"Supplemental Report. Additional changes to the data requirements from the previous reporting format to this new reporting format are described in this bulletin."]
[]
[null,null,"This annual reporting requirement shall continue in perpetuity unless and until explicit revocation by the NHID.  For future years, it is anticipated that the revised format"]
[null,null,"for reporting described within this bulletin will be used, but only one data collection process due July 15th will be conducted."]
[]
[null,null,"Upon receiving a report submission, the NHID will confirm receipt by e-mail. The submission will be reviewed for completeness. Insurance "]
[null,null,"carriers and TPAs are required to submit a filing which satisfies NHID standards for completeness and compliance by July 15 (March 15th, 2014 for a one-time special report). "]
[null,null,"Incomplete or non-compliant filings on July 15 (March 15th, 2014 for a one-time special report) will be subject to an administrative fine."]
[]
[null,null,"Fines"]
[null,null,"Fines will be assessed for failure to meet the submission deadline of July 15th or the special March 15th, 2014 deadline, for filing an incomplete supplemental report, "]
[null,null,"or for filing a report that is inaccurate.  Fines shall accrue on a daily basis. There will be no grace period to achieve compliance.  All Reports are expected "]
[null,null,"to be complete and accurate submissions on the date of submission."]

{"sheet":"Tabulation Methods & Issues","index":9,"n_rows":190,"n_cols":3,"rows_kept":190,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,null,"Tabulation Methods and Issues"]
[null,null,"Data shall be tabulated in three separate, mutually exclusive data collections: (1) the Main Data "]
[null,null,"collection, (2) the Limited Data collection, and (3) the Stop Loss Data Collection. The Main Data"]
[null,null,"collection shall include data for all members who receive services under a policy (whether individual "]
[null,null,"or employer-sponsored) with a New Hampshire situs or through a contract with a New Hampshire situs "]
[null,null,"issued by a third party administrator. The Limited Data collection shall include data for all New Hampshire "]
[null,null,"residents, or members who have a work location in New Hampshire (e.g. an out-of-state employer with a "]
[null,null,"branch location in New Hampshire), with a policy that does not have a New Hampshire situs. The carrier/TPA"]
[null,null,"shall submit data for all members who are employed at the New Hampshire branch location. The following chart "]
[null,null,"provides a visual description of the Main and Limited data collections:"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"The Stop Loss Data collection shall include data for all policies with Coverage Type "]
[null,null,"Code = \"STL\" (As defined in Attachment B-1). No policies with a Coverage Type Code = \"STL\" "]
[null,null,"should be included in either the Main Data collection or the Limited Data collection."]
[]
[null,null,"The tabulation information and issues below should be considered within each data collection separately."]
[]
[null,null,"Tabulation of Information"]
[null,null,"A reporting record shall include unique combinations of the coverage category,"]
[null,null,"market type (market category code), and benefit structure. Any difference in"]
[null,null,"benefit structure due to covered benefits specified as “exception variables,” member"]
[null,null,"liabilities (i.e. copay, deductible and coinsurance) or any other variable listed in this"]
[null,null,"report, means that data needs to be reported on a separate row."]
[]
[null,null,"Carriers shall submit one record for each type of coverage and benefit structure."]
[null,null,"For example, if a carrier provides multiple employers with only two types of HMO"]
[null,null,"policies, one an HMO with a low deductible and another with a high deductible, the"]
[null,null,"carrier shall submit two separate records with the corresponding member months,"]
[null,null,"premium, and claims."]
[]
[null,null,"Carriers issuing stop loss coverage to the employer groups for which they also"]
[null,null,"administer the self-insured health benefits shall submit one record for each type of "]
[null,null,"coverage: the self-insured health coverage and the stop loss coverage."]
[]
[null,null,"The information described below shall be submitted in the format prescribed in"]
[null,null,"Attachment A. Please note that there are a series of Exception Variables (EV)"]
[null,null,"listed in Attachment A and in the report template. When the insurance policy"]
[null,null,"covers the indicated service, leave the field blank in the report submission. When"]
[null,null,"the insurance policy does not offer coverage for the indicated service at all, submit"]
[null,null,"“NC” in the appropriate field for that policy. If the insurance policy generally covers "]
[null,null,"the indicted service but the coverage does not meet the coverage definition provided"]
[null,null,"in Attachment A, submit \"DM\" in the appropriate field for that policy.  Do NOT substitute"]
[null,null,"field requirements with \"Y\", \"N\",   \"NA\", or anything not specified in the reporting requirement.  "]
[null,null,"Do not change column headings.  Do not insert or delete columns."]
[]
[null,null,"Tabulation Issues - Multiple Carriers"]
[null,null,"The Department recognizes that there may be instances where more than one"]
[null,null,"carrier is involved in administrating policies for a common employer in conjunction"]
[null,null,"with that employer’s health insurance benefits. For self-insured plans, both the"]
[null,null,"carrier administering the plan and the carrier writing the stop loss coverage shall"]
[null,null,"submit a supplemental report."]
[]
[null,null,"The following guidelines clarify, in those instances when more than one carrier is"]
[null,null,"involved with providing coverage to a single employer, which carrier has the"]
[null,null,"responsibility to include the coverage in its tabulation."]
[]
[null,"-","Data on reinsurance policies, insurance policies written by a carrier to"]
[null,null,"another carrier, shall not be tabulated and shall not be included with"]
[null,null,"the required supplemental report."]
[null,"-","Stop-loss insurance, or group excess loss insurance issued to an"]
[null,null,"employer or other group, shall be reported by the writing carrier. It is"]
[null,null,"considered direct insurance and carriers writing such coverage shall be"]
[null,null,"responsible for submitting information on their written polices."]
[null,"-","In the event that the entity administering coverage is different than"]
[null,null,"the carrier writing coverage, the writing carrier shall be responsible"]
[null,null,"for submitting the required information. Carriers writing risks shall"]
[null,null,"be responsible for submitting information on policies covering the"]
[null,null,"underwritten risks. Entities responsible only for policy administration"]
[null,null,"shall not be responsible for tabulating data on policies that they"]
[null,null,"administer when such coverage is written on another carrier’s paper"]
[null,null,"and reported by that carrier."]
[null,"-","TPAs or carriers administering an employer-sponsored health"]
[null,null,"insurance benefit plan shall submit records for all self-insured plans"]
[null,null,"that they administer. TPAs must file a supplemental report for this"]
[null,null,"type of activity regardless of whether a stop-loss writer is filing"]
[null,null,"information for the same employer."]
[null,"-","Similarly, a stop loss carrier must file the information prescribed in"]
[null,null,"this section regardless of whether a TPA, or some other carrier, is"]
[null,null,"filing a supplemental report for the same employer."]
[]
[null,null,"Tabulation Issues – Geographic Location"]
[null,null,"The policy geographic location code shall be based on the specific business location"]
[null,null,"of the policyholders; where the policy is sitused (refer to \"Situs\" in definition section "]
[null,null,"of the bulletin).  For NH residents working at a branch location in NH, the policyholder "]
[null,null,"location may be out of state.  All codes are specified in Attachment D."]
[]
[null,null,"All policies included in the Main Data collection should be NH policies with a geographic "]
[null,null,"location code other than ‘Y’, while all policies included in the Limited Data collection "]
[null,null,"should be non-NH policies with a geographic location code of ‘Y’. Policies included in"]
[null,null,"the Stop Loss Data collection shuold use the appropriate code from Attachment D,"]
[null,null,"whether 'Y' or another value."]
[]
[null,null,"Carriers shall use a county code of ‘Z’ to identify NH locations for which there is no"]
[null,null,"county code mapped to the NH zip code that is stored by the carrier. Whenever a"]
[null,null,"code of ‘Z’ is used, the carrier shall include a note record specifying the NH zip code"]
[null,null,"for which there is no county code match."]
[]
[null,null,"Acceptable Methods for Estimating Data"]
[null,null,"In certain instances, a carrier may not have the information it needs to tabulate"]
[null,null,"data as prescribed. For example, a carrier writing stop-loss, or group excess"]
[null,null,"insurance may not know who the employer’s employees are. Carriers and TPAs "]
[null,null,"shall provide data at the most detailed level at which the carrier  or TPA keeps the data. "]
[null,null,"For this example, the number of certificate holders, e.g. employees, and the number "]
[null,null,"of covered lives shall be estimated based on data used by the carrier to price the business."]
[]
[null,null,"Where carriers use estimation methods, the carrier shall include, as part of its"]
[null,null,"supplemental report, an explanation in the notes section to explain why estimation"]
[null,null,"methods were necessary and the methods used to generate the estimates. The"]
[null,null,"NHID reserves the right to approve or disapprove the method of estimation."]
[]
[null,null,"Acceptable Methods for Submission"]
[null,null,"All supplemental reports will be processed electronically. Carriers are required to"]
[null,null,"submit the supplemental report in an MS Excel Workbook format provided by the Department."]
[null,null,"The Department has created templates that are available for download from the Department’s"]
[null,null,"website.  "]
[]
[null,null,"The templates are in the Excel file called Supplemental Report Template 2013_Jul.xlsm "]
[null,null,"(Supplemental Report Template 2012 Mar.xlsm for the special submission due March15, 2014). "]
[null,null,"This file shall be used as a template for creating new spreadsheets. After downloading"]
[null,null,"this file to a local directory, in Windows Explorer, right click on the downloaded file,"]
[null,null,"and select New. This will create a new workbook file based on the downloaded"]
[null,null,"template. Do not change the worksheet names or column headings in the template."]
[]
[]
[null,null,"All carriers shall create a workbook using the Supplemental Report Excel Template."]
[null,null,"Carriers shall name the workbook SIR<cocode>.xls based on the carrier NAIC code. "]
[null,null,"The naming is important for processing purposes."]
[]
[null,null,"After data have been input into the worksheet, please use the button on the "]
[null,null,"“Transmittal” sheet to check that data fields are formatted correctly and only "]
[null,null,"valid codes have been reported. Any possibly invalid entries will be highlighted "]
[null,null,"and should be reviewed and, if necessary, corrected prior to submission.  Note"]
[null,null,"that macros must be enabled in order to run the validity check."]
[]
[]
[null,null,"All supplemental reports shall be transmitted via electronic mail to the Insurance"]
[null,null,"Department. Supplemental Reports shall be electronically mailed to"]
[null,null,"nhsuppreport@ins.nh.gov. All such correspondence shall use the following text"]
[null,null,"as the subject header, “ATTN: Statistician, Insurance Department Supplemental"]
[null,null,"Report.”"]
[]
[null,null,"Data Reconciliation"]
[null,null,"To assist carriers in ensuring consistent reporting practices and that the data submission "]
[null,null,"is reasonable in relation to the reporting requirements, we have included additional data "]
[null,null,"reconciliation checks. These data checks compare the data in this submission to carrier"]
[null,null,"reported data in two additional reports, specifically the NAIC Supplemental Health Care "]
[null,null,"Exhibit (SHCE) for New Hampshire and the NH Comprehensive Health Information System (CHIS). "]
[null,null,"Instructions and a template for the data reconciliations can be found on the “Data Reconciliation”"]
[null,null,"sheet in the Supplemental Report Excel Template. These reconciliations should be performed "]
[null,null,"prior to the template being submitted to the Department. While the data submission is not"]
[null,null,"required to reconcile exactly to the other data sources, explanations of differences must be "]
[null,null,"provided.  For example, claims in the SHCE may reflect paid claims plus the change in unpaid "]
[null,null,"claims (current year end minus prior year end), while the Supplemental Report may reflect"]
[null,null,"incurred and paid claims plus an estimate for unpaid claims, which may result in a difference"]
[null,null,"that can be explained. Please note that comparisons are made only on the data that "]
[null,null,"overlaps between the reports and should reconcile. There will be some data that are included "]
[null,null,"in the Supplemental Report and are not included in the SHCE (e.g. claims and premium with "]
[null,null,"Coverage Type Code = 'ASO' or 'ASW')."]
[]
[null,null,"If either the SHCE or CHIS data are not available for use in the comparison, the reason for "]
[null,null,"which should be provided on the “Notes” sheet in the Supplemental Report Excel Template."]
[]
[null,null,"Confidentiality"]
[null,null,"(a) Each company or person from whom information is sought shall provide the"]
[null,null,"required information to the commissioner."]
[]
[null,null,"(b) The Supplemental Report filed by each health carrier shall be subject to the"]
[null,null,"New Hampshire Right-to-Know law, RSA 91-A. The Right-to-Know law shall not be"]
[null,null,"deemed to limit the commissioner's authority to use or disclose such information"]
[null,null,"which the commissioner in the exercise of his/her duty may deem appropriate"]
[null,null,"pursuant to RSA 400-A:25."]
[]
[null,null,"Any questions should be directed to Tyler Brannen, Health Care Statistician at"]
[null,null,"tyler.brannen@ins.nh.gov."]

{"sheet":"Coverage Type","index":10,"n_rows":33,"n_cols":14,"rows_kept":33,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Coverage Type",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description: ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for coverage type:"]
[null,"Three digit character code for coverage type: UND, ASW, ASO, STL, STN, or MCD ",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"as fully described in Attachment B-1. All policies in the Stop Loss Data Collection",null,null,null,null,null,null,null,null,null,null,null,"UND"]
[null,"should have the Coverage Type = \"STL\".",null,null,null,null,null,null,null,null,null,null,null,"ASW"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"ASO"]
[null,"Attachment B-1",null,null,null,null,null,null,null,null,null,null,null,"STL"]
[null,"All coverage type character codes are exactly three characters. Carriers shall use",null,null,null,null,null,null,null,null,null,null,null,"STN"]
[null,"the codes listed herein.",null,null,null,null,null,null,null,null,null,null,null,"MCD"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"OTH"]
["-","ASW: For self-funded plans that are administered by a TPA, where the employer has",null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,"purchased stop-loss, or group excess, insurance coverage, carriers shall use a code",null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]
[null,"of ASW."]
[]
["-","ASO: For self-funded plans that are administered by a TPA, where the employer"]
[null,"has not purchased stop-loss, or group excess insurance coverage, carriers shall use"]
[null,"a code of ASO."]
[]
["-","STL: For stop-loss, or group excess loss insurance, carriers shall use STL."]
[]
["-","STN: For short-term non-renewable health insurance, as defined per RSA 415:5 III,"]
[null,"carriers shall use a code of STN."]
[]
["-","MCD: Insurance sold to protect the health of Medicaid eligible individuals, generally"]
[null,"purchased by state governments, shall not be considered major medical expense."]
[null,"Carriers shall report such business as other than major medical expense coverage"]
[null,"and use the Medicaid related insurance code of MCD."]
[]
["-","UND: For plans underwritten by the carrier and not referenced above, use code UND."]
[]
["-","OTH: For any other plan, use OTH. Carriers using this code shall provide an explanation"]
[null,"on the Notes worksheet."]

{"sheet":"Plan Type","index":11,"n_rows":24,"n_cols":15,"rows_kept":24,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Plan Type",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Three digit character code for plan type: HMO, POS, PPO, EPO, or FFS as fully described in Attachment B-2. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for plan type:"]
[null,"When determining the plan type as HMO, POS, EPO, or FFS, carriers shall use the same definition ",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"as what is applied in field MC802 in the Uniform Reporting System for Health Care Claims Data Sets.",null,null,null,null,null,null,null,null,null,null,null,"HMO"]
[null,"For policies with Coverage Type = \"STL\" only, if the Plan Type of the underlying health plan is not",null,null,null,null,null,null,null,null,null,null,null,"POS"]
[null,"available, input \"N/A\".",null,null,null,null,null,null,null,null,null,null,null,"PPO"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"EPO"]
[null,"Attachment B-2",null,null,null,null,null,null,null,null,null,null,null,"FFS"]
[null,"All plan type character codes are exactly three characters. Carriers shall use the",null,null,null,null,null,null,null,null,null,null,null,"N/A","for Coverage Type = \"STL\" only"]
["-","codes listed herein."]
[]
[null,"FFS: For indemnity-type plans, with no managed care features, carriers shall use a code",null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
["-","of FFS, (Fee-for-Service).",null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]
[]
["-","PPO: For Preferred Provider Organization type plans, carriers shall use a code of PPO."]
[]
["-","EPO: For Exclusive Provider Organization type plans, carriers shall use a code of EPO."]
[]
["-","POS: For Point of Service type plans, carriers shall use a code of POS."]
[]
[null,"HMO: For Health Maintenance Organizations managed care plans, carriers shall use a"]
[null,"code of HMO."]

{"sheet":"Market Category","index":12,"n_rows":101,"n_cols":17,"rows_kept":101,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Market Category",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Three or four digit character code for identifying employer size, student insurance ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for market category:"]
[null,"policies, or blanket insurance. Employer size is based on the number of eligible ",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"employees in the group.  For qualified association trusts, assign the group size",null,null,null,null,null,null,null,null,null,null,null,"IND","GS4","BLS","SNM"]
[null," applicable to each subgroup within the the association. Codes are in Attachment C.",null,null,null,null,null,null,null,null,null,null,null,"FCH","GLG1","BLT","SIM"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"GCV","GLG2","BLU","SIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"GS1","BLC","SLG","OTH"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"GS2","BLE","STS"]
[null,"Attachment C",null,null,null,null,null,null,null,null,null,null,null,"GS3","BLV","SMG"]
[]
[null,"All market category character codes below. Carriers shall use the codes listed",null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,"herein.  For policies sold and issued through a qualified association trust, carriers ",null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]
[null,"shall assign the code based on the employee count of the employer sub-group"]
[]
["-","IND: For policies sold and issued directly to individuals, other than those sold on a"]
[null,"franchise basis, as defined per RSA 415:19, or as group conversion policies, required"]
[null,"per RSA 415:18 VII (a), carriers shall use a code of IND."]
[]
["-","FCH: For policies sold and issued directly to individuals on a franchise basis, as defined"]
[null,"per RSA 415:19, carriers shall use a code of FCH."]
[]
["-","GCV: For policies sold and issued directly to individuals as group conversion policies, as"]
[null,"required per RSA 415:18 VII (a), carriers shall use a code of GCV."]
[]
["-","GS1: For policies sold and issued directly to employers having exactly one employee,"]
[null,"carriers shall use a code of GS1."]
[]
["-","GS2: For policies sold and issued directly to employers having between two and nine"]
[null,"employees, carriers shall use a code of GS2."]
[]
["-","GS3: For policies sold and issued directly to employers having between 10 and 25"]
[null,"employees, carriers shall use a code of GS3."]
[]
["-","GS4: For policies sold and issued directly to employers having between 26 and 50"]
[null,"employees, carriers shall use a code of GS4."]
[]
["-","GLG1: For policies sold and issued directly to employers having between 51 and 99"]
[null,"employees, carriers shall use a code of GLG1."]
[]
["-","GLG2: For policies sold and issued directly to employers having 100 or more employees,"]
[null,"carriers shall use a code of GLG2."]
[]
["-","BLC: For policies sold and issued as blanket health insurance policies to a common"]
[null,"carrier, carriers shall use a code of BLC."]
[]
["-","BLE: For policies sold and issued as blanket health insurance policies to an employer,"]
[null,"carriers shall use a code of BLE."]
[]
["-","BLV: For policies sold and issued as blanket health insurance policies to a volunteer fire"]
[null,"department, first aid, or other such volunteer group, carriers shall use a code of"]
[null,"BLV."]
[]
["-","BLS: For policies sold and issued as blanket health insurance policies to a sports team or"]
[null,"a camp, carriers shall use a code of BLS."]
[]
["-","BLT: For policies sold and issued as blanket health insurance policies to a travel agency,"]
[null,"or other organization that provides travel-related services, carriers shall use a code"]
[null,"of BLT."]
[]
["-","BLU: For policies sold and issued as blanket health insurance policies to a university or"]
[null,"college, carriers shall use a code of BLU."]
[]
["-","SLG: For policies sold and issued as student major medical expense large group coverage"]
[null,"to enrolled students at an accredited college, university, or other educational"]
[null,"institution, carriers shall use a code of SLG."]
[]
["-","STS: For policies sold and issued as group short term student health insurance, carriers"]
[null,"shall use a code of STS."]
[]
["-","SMG: For policies sold and issued as student major medical group health insurance,"]
[null,"carriers shall use code SMG."]
[]
["-","SNM: For policies sold and issued as student group health insurance that is not major"]
[null,"medical coverage, carriers shall use a code of SNM."]
[]
["-","SIM: For policies sold and issued as student individual major medical health insurance,"]
[null,"carriers shall use a code of SIM."]
[]
["-","SIN: For policies sold and issued as student individual health insurance that is not major"]
[null,"medical coverage, carriers shall use a code of SIN."]
[]
["-","OTH: For policies sold to other types of entities, carriers shall use a code of OTH."]
[null,"Carriers using this market code shall provide an explanation on the Notes"]
[null,"worksheet."]
[]
[]
[null,"Definitions:"]
[null,"“Blanket health insurance” is as defined under RSA 415:18 I-a and"]
[null,"means that form of accident and health insurance that is not \"health"]
[null,"coverage'' under RSA 420-G:2, IX, that does not require individual"]
[null,"applications from covered persons, and that does not require a carrier"]
[null,"to furnish each person with a certificate of coverage."]
[]
[null,"“Certificate holder” shall have its standard language meaning for"]
[null,"insurance writers and their written coverage. For employer-sponsored"]
[null,"group coverage, the employee or subscriber shall be the"]
[null,"certificate holder. For individual coverage, the policyholder shall be"]
[null,"the certificate holder. For other types of group coverage, the"]
[null,"certificate holder shall mean the person who is the principal insured."]

{"sheet":"Geographic Location","index":13,"n_rows":189,"n_cols":14,"rows_kept":189,"cut":false,"hidden":false,"merged":[[28,2,31,2]]}
[]
[null,"Policyholder Geographic Location",null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"One digit county codes based on the location of the policy holder (not member).",null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Geographic Location:"]
[null,"Codes are in Attachment D.",null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,"B","M"]
[null,"The Main Data Collection is for policies with a NH situs only and should not contain any Y's populated in the",null,null,null,null,null,null,null,null,null,null,"L","R"]
[null,"Policyholder Geographic Location' field of the submission.",null,null,null,null,null,null,null,null,null,null,"E","D"]
[null,"The Limited Data Collection is for policies without NH situs and should only contain any Y's populated in the",null,null,null,null,null,null,null,null,null,null,"S","N"]
[null,"Policyholder Geographic Location' field of the submission.",null,null,null,null,null,null,null,null,null,null,"G","Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,"H","Z"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,"Attachment D",null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]
[null,"Policyholder Geographic Location"]
[]
[null,"County ","County Code"]
[null,"Belknap ","B"]
[null,"Carroll ","L"]
[null,"Cheshire ","E"]
[null,"Coos ","S"]
[null,"Grafton ","G"]
[null,"Hillsborough ","H"]
[null,"Merrimack","M"]
[null,"Rockingham","R"]
[null,"Strafford","D"]
[null,"Sullivan","N"]
[null,"Non-NH","Y"]
[null,"NH; unable to match ","Z",null,null,null,null,null,null,null,null,"Definition:"]
[null,"zip code to county code",null,null,null,null,null,null,null,null,null,"\"Situs\" of a policy shall be defined as the jurisdiction in which the policy is issued or delivered"]
[null,"(Zip code(s) must be ",null,null,null,null,null,null,null,null,null,"as stated in the policy.  For employer business issued through a qualified association"]
[null,"provided to the NHID)",null,null,null,null,null,null,null,null,null,"trust, the situs shall be based on the location of each member employer. The intent of this "]
[null,null,null,null,null,null,null,null,null,null,null,"definition is to be consistent with the instructions for the NAIC Supplemental Health Care "]
[null,null,null,null,null,null,null,null,null,null,null,"Exhibit.  Carriers should apply the same consideration when determining situs for this report"]
[null,"Note:  The above codes should be assigned based on the location of the policyholder (not the member).  ",null,null,null,null,null,null,null,null,null,"as they do for the Supplemental Health Care Exhibit. TPAs shall determine situs of their "]
[null,"Non-NH policyholder data (with County Code of “Y”) shall be reported on the Limited Data tab and all other data ",null,null,null,null,null,null,null,null,null,"contracts in a like manner."]
[null,"shall be reported on the Main Data tab."]
[]
[]
[]
[null,"Attachment E"]
[null,"Translation Table – Zip Codes to NH County Codes"]
[]
[null,"Zip Code","Through","County","Code"]
[null,"03218","03220","Belknap","B"]
[null,"03225","03226","Belknap","B"]
[null,"03237",null,"Belknap","B"]
[null,"03246","03249","Belknap","B"]
[null,"03252","03253","Belknap","B"]
[null,"03256",null,"Belknap","B"]
[null,"03269",null,"Belknap","B"]
[null,"03276",null,"Belknap","B"]
[null,"03289",null,"Belknap","B"]
[null,"03298","03299","Belknap","B"]
[null,"03809","03810","Belknap","B"]
[null,"03837",null,"Belknap","B"]
[null,"03227",null,"Carroll","L"]
[null,"03254",null,"Carroll","L"]
[null,"03259",null,"Carroll","L"]
[null,"03812","03814","Carroll","L"]
[null,"03816","03818","Carroll","L"]
[null,"03830","03832","Carroll","L"]
[null,"03836",null,"Carroll","L"]
[null,"03838",null,"Carroll","L"]
[null,"03845","03847","Carroll","L"]
[null,"03849","03850","Carroll","L"]
[null,"03853",null,"Carroll","L"]
[null,"03860",null,"Carroll","L"]
[null,"03864",null,"Carroll","L"]
[null,"03872",null,"Carroll","L"]
[null,"03875",null,"Carroll","L"]
[null,"03882","03883","Carroll","L"]
[null,"03886",null,"Carroll","L"]
[null,"03887",null,"Carroll","L"]
[null,"03890","03897","Carroll","L"]
[null,"03431","03435","Cheshire","E"]
[null,"03441",null,"Cheshire","E"]
[null,"03443","03448","Cheshire","E"]
[null,"03450","03457","Cheshire","E"]
[null,"03461","03467","Cheshire","E"]
[null,"03469","03470","Cheshire","E"]
[null,"03602",null,"Cheshire","E"]
[null,"03604",null,"Cheshire","E"]
[null,"03608","03609","Cheshire","E"]
[null,"03570",null,"Coos","S"]
[null,"03575","03579","Coos","S"]
[null,"03581","03584","Coos","S"]
[null,"03587","03598","Coos","S"]
[null,"03215",null,"Grafton","G"]
[null,"03217",null,"Grafton","G"]
[null,"03222","03223","Grafton","G"]
[null,"03232",null,"Grafton","G"]
[null,"03238","03241","Grafton","G"]
[null,"03245",null,"Grafton","G"]
[null,"03251",null,"Grafton","G"]
[null,"03262",null,"Grafton","G"]
[null,"03264","03266","Grafton","G"]
[null,"03274",null,"Grafton","G"]
[null,"03279",null,"Grafton","G"]
[null,"03282",null,"Grafton","G"]
[null,"03293",null,"Grafton","G"]
[null,"03561",null,"Grafton","G"]
[null,"03574",null,"Grafton","G"]
[null,"03580",null,"Grafton","G"]
[null,"03585",null,"Grafton","G"]
[null,"03740","03741","Grafton","G"]
[null,"03748","03750","Grafton","G"]
[null,"03755","03769","Grafton","G"]
[null,"03771",null,"Grafton","G"]
[null,"03774","03780","Grafton","G"]
[null,"03784","03785","Grafton","G"]
[null,"03031",null,"Hillsborough","H"]
[null,"03033",null,"Hillsborough","H"]
[null,"03043",null,"Hillsborough","H"]
[null,"03045",null,"Hillsborough","H"]
[null,"03047","03052","Hillsborough","H"]
[null,"03054","03071","Hillsborough","H"]
[null,"03076",null,"Hillsborough","H"]
[null,"03082","03086","Hillsborough","H"]
[null,"03101","03105","Hillsborough","H"]
[null,"03107","03111","Hillsborough","H"]
[null,"03244",null,"Hillsborough","H"]
[null,"03281",null,"Hillsborough","H"]
[null,"03440",null,"Hillsborough","H"]
[null,"03442",null,"Hillsborough","H"]
[null,"03449",null,"Hillsborough","H"]
[null,"03458",null,"Hillsborough","H"]
[null,"03468",null,"Hillsborough","H"]
[null,"03046",null,"Merrimack","M"]
[null,"03106",null,"Merrimack","M"]
[null,"03216",null,"Merrimack","M"]
[null,"03221",null,"Merrimack","M"]
[null,"03224",null,"Merrimack","M"]
[null,"03229","03231","Merrimack","M"]
[null,"03233","03235","Merrimack","M"]
[null,"03242","03243","Merrimack","M"]
[null,"03255",null,"Merrimack","M"]
[null,"03257","03258","Merrimack","M"]
[null,"03260",null,"Merrimack","M"]
[null,"03263",null,"Merrimack","M"]
[null,"03268",null,"Merrimack","M"]
[null,"03272","03273","Merrimack","M"]
[null,"03275",null,"Merrimack","M"]
[null,"03278",null,"Merrimack","M"]
[null,"03287",null,"Merrimack","M"]
[null,"03301","03307","Merrimack","M"]
[null,"03032",null,"Rockingham","R"]
[null,"03034","03042","Rockingham","R"]
[null,"03044",null,"Rockingham","R"]
[null,"03053",null,"Rockingham","R"]
[null,"03073",null,"Rockingham","R"]
[null,"03077","03079","Rockingham","R"]
[null,"03087",null,"Rockingham","R"]
[null,"03261",null,"Rockingham","R"]
[null,"03290","03291","Rockingham","R"]
[null,"03801","03804","Rockingham","R"]
[null,"03811",null,"Rockingham","R"]
[null,"03819",null,"Rockingham","R"]
[null,"03826","03827","Rockingham","R"]
[null,"03833",null,"Rockingham","R"]
[null,"03840","03844","Rockingham","R"]
[null,"03848",null,"Rockingham","R"]
[null,"03854",null,"Rockingham","R"]
[null,"03856","03859","Rockingham","R"]
[null,"03862",null,"Rockingham","R"]
[null,"03865",null,"Rockingham","R"]
[null,"03870","03871","Rockingham","R"]
[null,"03873","03874","Rockingham","R"]
[null,"03885",null,"Rockingham","R"]
[null,"03805",null,"Strafford","D"]
[null,"03815",null,"Strafford","D"]
[null,"03820","03825","Strafford","D"]
[null,"03835",null,"Strafford","D"]
[null,"03839",null,"Strafford","D"]
[null,"03851","03852","Strafford","D"]
[null,"03855",null,"Strafford","D"]
[null,"03866","03869","Strafford","D"]
[null,"03878",null,"Strafford","D"]
[null,"03884",null,"Strafford","D"]
[null,"03280",null,"Sullivan","N"]
[null,"03284",null,"Sullivan","N"]
[null,"03601",null,"Sullivan","N"]
[null,"03603",null,"Sullivan","N"]
[null,"03605","03607","Sullivan","N"]
[null,"03743","03746","Sullivan","N"]
[null,"03751","03754","Sullivan","N"]
[null,"03770",null,"Sullivan","N"]
[null,"03772","03773","Sullivan","N"]
[null,"03781","03782","Sullivan","N"]

{"sheet":"St, Fed, Muni, HK","index":14,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"State, Federal, Municipal, or Healthy Kids",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Are the data for the state of NH, federal, municipal or Healthy Kids account? Input",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for State, Federal, Municipal, or Healthy Kids:"]
[null,"“S” for State, “F” for federal, “M” for municipal, \"H\" for Healthy Kids, or “O” for other accounts.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"S"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"F"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"M"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"H"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"O"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Qualified Assoc Trust","index":15,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Qualified Association Trust",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Are the data for a Qualified Association Trust? Input \"Y\" for yes, \"N\" for no. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Qualified Association Trust:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Prof Employer Org","index":16,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Professional Employer Organization",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Are the data for a Professional Employer Organization? Input \"Y\" for yes, \"N\" for no. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Professional Employer Organization:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"HealthFirst","index":17,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"HealthFirst",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Are the data for a HealthFirst product(s)? Input \"Y\" for yes, \"N\" for no. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for HealthFirst:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Calendar Year","index":18,"n_rows":14,"n_cols":15,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Calendar Year",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Calendar year for which the data is reported.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for calendar year:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please format entries to GENERAL"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,2012," (or the correct year for which reporting data)"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"This is the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Policyholder Months","index":19,"n_rows":25,"n_cols":14,"rows_kept":25,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Number of Policyholder Months",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Total number of covered months for the policyholder (usually employer for group",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for policyholder months:"]
[null,"policies, or individual for non-group policies).  One policyholder covered for ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"one full year would be equal to 12. Policy months may not be additive. If an ",null,null,null,null,null,null,null,null,null,null,null,12]
[null,"account has two rows because of the purchase of multiple products, the policy",null,null,null,null,null,null,null,null,null,null,null,58]
[null,"months will be the same.",null,null,null,null,null,null,null,null,null,null,null,106]
[null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[]
[null,"Definitions:"]
[null,"“Policy” shall have its standard language meaning for insurance "]
[null,"writers.  For employer-sponsored group coverage, where the coverage "]
[null,"is written directly for the employer’s benefit plan, the employer shall ",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"be considered the policyholder.  A policy that is issued in New "]
[null,"Hampshire shall include any policy that provides coverage to the "]
[null,"employees of a New Hampshire employer that has a business location "]
[null,"in New Hampshire.  An employer's branch location in New "]
[null,"Hampshire shall be considered a New Hampshire employer, and the "]
[null,"carrier/TPA shall submit data for all members who are employed at "]
[null,"that branch location.  For employer-sponsored group coverage, issued "]
[null,"to a qualified association trust, each member employer shall be "]
[null,"considered a separate policyholder.  For all association business, each "]
[null,"member employer shall be considered as a separate policyholder.  "]
[null,"TPAs shall report policyholders in a like manner.  "]

{"sheet":"Subscriber Months","index":20,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Number of Subscriber Months",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Total number of covered months for the subscriber (employee or individual).",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for subscriber months:"]
[null,"One employee covered for one full year would be equal to 12.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,58]
[null,null,null,null,null,null,null,null,null,null,null,null,null,106]
[null,null,null,null,null,null,null,null,null,null,null,null,null,10]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Member Months","index":21,"n_rows":17,"n_cols":14,"rows_kept":17,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Number of Member Months",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Includes both the total number of covered life months for the subscriber and",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for member months:"]
[null,"for any covered spouses and dependents.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,12]
[null,null,null,null,null,null,null,null,null,null,null,null,null,58]
[null,"Definitions:",null,null,null,null,null,null,null,null,null,null,null,106]
[null,"“Covered lives” or “members” shall include all individuals, employees ",null,null,null,null,null,null,null,null,null,null,null,10]
[null,"and dependents for which the health carrier has an obligation to "]
[null,"adjudicate, pay or disburse claim payments.  Data submission "]
[null,"requirements apply to all members who receive services under a "]
[null,"policy sold to a New Hampshire employer with a business location in "]
[null,"New Hampshire, or to a resident of New Hampshire who receives ",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"services under a policy issued by the carrier or services by the third "]
[null,"party administrator.  For employer-sponsored group coverage, "]
[null,"covered lives would include certificate holders and their dependents.  "]

{"sheet":"Total Premium","index":22,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Total Premium",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"“Premium” shall be calculated as “earned” premium, or the total amount of premium from",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for total premium:"]
[null,"policyholders to provide insurance coverage during the reporting year.  ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"Earned premium = premiums collected + change in due and uncollected – change in ",null,null,null,null,null,null,null,null,null,null,null,1569]
[null,"unearned and advance premium. If premium is collected prior to January 1, to provide",null,null,null,null,null,null,null,null,null,null,null,554]
[null,"insurance coverage during the reported calendar year, then it must be included in this ",null,null,null,null,null,null,null,null,null,null,null,1506.88]
[null,"column. The Commissioner may approve the use of a reasonable proxy upon the ",null,null,null,null,null,null,null,null,null,null,null,1353.5]
[null,"carrier’s provision of documentation demonstrating that the use of the same does not ",null,null,null,null,null,null,null,null,null,null,null,1008]
[null,"materially distort the carrier’s data submission.",null,null,null,null,null,null,null,null,null,null,null,2085]
[null,null,null,null,null,null,null,null,null,null,null,null,null,4000]
[null,"For self-insured business, Third Party Administrators and carriers shall calculate"]
[null,"earned premium by aggregating the total funds collected from contracted accounts",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"to provide for all claims and expenses associated with the administration of the employer’s "]
[null,"benefit plan.  These funds include provisions for claims (net of stop-loss recoveries), administration, "]
[null,"premium for stop-loss coverage (for policies with Coverage Type of \"ASW\"), profit margins, commissions,"]
[null,"wellness programs, network fees, and disease management programs. "]
[]
[null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"Claims Columns","index":23,"n_rows":31,"n_cols":14,"rows_kept":31,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Total Claims, Claims Incurred & Paid, Claims Incurred & Unpaid, Other Payments,",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null," and Member Responsibility"]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for total claims, claims incurred & paid, claims incurred & unpaid, other payments and"]
[null,"Total claims incurred on behalf of the covered members in the reporting class during the calendar year for which the",null,null,null,null,null,null,null,null,null,null,null,"     member responsibility:"]
[null,"supplemental report is being made.   Note that total claims are reported on an accrual basis for calendar year.  All ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"claims with a date of service during the reporting year are to be included as claims paid in this field.  If necessary,",null,null,null,null,null,null,null,null,null,null,null,1220.07]
[null,"actuarial completion factors should be used to estimate incurred claims and should be based on when the carrier",null,null,null,null,null,null,null,null,null,null,null,161.15]
[null,"extracts the data for the Supplemental Report.",null,null,null,null,null,null,null,null,null,null,null,50.36]
[null,null,null,null,null,null,null,null,null,null,null,null,null,30.22]
[null,"Incurred claims shall include:",null,null,null,null,null,null,null,null,null,null,null,302.16000000000003]
[null,"-claims incurred during the reporting period and paid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,166.63]
[null,"-claims incurred and reported during the reporting period but unpaid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,4000]
[null,"-claims incurred but not reported during the reporting period.",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"-other payments and credits such as capitation, incentive payments, prescription drug rebates, etc. "]
[]
[null,"For the Main Data Collection, for insured business, incurred claims should be consistent with what is reported in Part 1, Line 5 of the "]
[null,"NAIC Supplemental Health Care Exhibit, allowing for variances due to any restatement of "]
[null,"unpaid claims with additional paid claim runout. "]
[]
[null,"For self-insured business, TPAs and carriers shall calculate incurred claims on a similar basis with the following additions:"]
[null,"-incurred claims shall be net of any stop-loss recoveries."]
[null,"-include amounts paid for stop-loss coverage"]
[]
[null,"The amount reported in this field should be the sum of the following three fields: (1) Claims Incurred "]
[null,"and Paid, (2) Claims Incurred and Unpaid, and (3) Other Payments and Credits."]
[]
[null,"Claims Incurred and Paid","Includes claims incurred during the reporting period and paid prior to when the carrier extracts the data for the Supplemental Report."]
[null,"Claims Incurred and Unpaid","Claims incurred during the reporting period and unpaid (payable) as of the data extract including both (1) claims reported but still payable (sometimes referred to as in course of settlement)and (2) claims not reported and payable (sometimes referred to as incurred but not reported)."]
[null,"Other Payments and Credits","Includes other payments made such as capitation, incentive payments, etc. or credits received such as prescription drug rebates which are included in medical expense as reported for the carrier’s Statement of Revenue and Expenses, or its equivalent, which is a required component of the annual statement filing.  For policies with Coverage Type = \"ASW\", TPAs and carriers should report any stop-loss recoveries and stop-loss premiums in this field."]
[null,"Member Responsibility","For the claims included in the “Total Claims” field, report the total known amount (that is, those associated with incurred and paid claims) of deductibles, coinsurance amounts, and copayments or any balance-billing for which the member is responsible. This field should not include amounts for denied claims or claims covered by another payer due to coordination of benefits."]

{"sheet":"Plan ID","index":24,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Plan ID",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"This is the 14-character HIOS Plan ID (Standard component). ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Plan ID:"]
[null,"This field may not be available for all market segments; input \"N/A\" where not available.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS and format as TEXT."]
[null,"Note: this field does not need to be populated for 2012 data, but will be required beginning with 2013 data.",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
[null,"Until that time, input \"N/A\"."]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry format submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Plan Code","index":25,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Plan Code",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"This identifier should be the same Plan Code or Name used in the NH Individual and Small Group rate filings,",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Plan Code:"]
[null,"which is described in the Requirements for Accident and Health Insurance Rate Submissions User Manual",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS and format as TEXT."]
[null,"(found on the NHID website1).",null,null,null,null,null,null,null,null,null,null,null,"N/A"]
[null,"This field may not be available for all market segments; input \"N/A\" where not available."]
[null,"Note: this field does not need to be populated for 2012 data, but will be required beginning with 2013 data."]
[null,"Until that time, input \"N/A\"."]
[]
[]
[null,"[1]http://www.nh.gov/insurance/legal/documents/user_guide-v4.pdf or updated version, if available"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry format submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Policy Form Number","index":26,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Policy Form Number",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Policy Form Number associated with this health plan coverage.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Policy Form Number:"]
[null,"If Policy Form Number is not available, input \"N/A\".",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS and format as TEXT."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"TEXT FORM NUMBER"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N/A"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry format submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Exchange Indicator","index":27,"n_rows":14,"n_cols":15,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Exchange Indicator",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Is this health coverage plan available on the Exchange? Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Exchange Indicator:"]
[null,"Note: data for this field will not be available until 2014.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"Until that time, input \"N/A\".",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N/A","Until 2014"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Grandfathered Indicator","index":28,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Grandfathered Indicator",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Is this health coverage plan Grandfathered per the ACA definition? Input “Y” for Grandfathered plans",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Grandfathered Indicator:"]
[null,"or “N” for Non-Grandfathered plans.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"HDHP","index":29,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"HDHP",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Does the policy meet the IRS definition of a HDHP? Input \"Y\" for yes, \"N\" for no. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for HDHP:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Open","index":30,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Is this health coverage plan open?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Is this health coverage plan open or closed?  Input \"Y\" if open, \"N\" for closed.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"In closed blocks, only existing contracts are allowed to renew. Benefit options in closed ",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"blocks are not marketed or being sold to new customers. If at any time in the reporting ",null,null,null,null,null,null,null,null,null,null,null,"N"]
[null,"year a block becomes closed, it should be considered closed for the purpose of this report. "]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"New","index":31,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Is this a new health coverage plan?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Was this health coverage plan new in the calendar year for which the supplemental report is being made?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"A new health coverage plan is a benefit design that is being offered/marketed for the first time in this reporting year. ",null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Ded_Med","index":32,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Does Deductible apply to all Medical Services?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"Since many plans will be covering preventative office visits at 100%, consider only",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"other types of medical services when responding to this question.",null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Ded_Pharm","index":33,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Does Deductible apply to Pharmacy Services?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"The Deductible in this question refers to the Medical Deductible, not a Pharmacy-Specific Deductible.",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Prevent Svcs","index":34,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Are Preventive Services covered 100%?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"Preventive Services refers to the preventive services as defined ",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"and required in the Affordable Care Act as of the reporting year.",null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"MHSA","index":35,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Does this health coverage plan provide coverage for MH/SA?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Tiered Network","index":36,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Does this health coverage plan have a Tiered Network component?",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Input \"Y\" for yes, \"N\" for no.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,"A Tiered Network is defined as varying levels of cost sharing based on different networks of providers set up to cover ",null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,"a broad range of services that are considered in-network. An arrangement that is specific to a limited number of",null,null,null,null,null,null,null,null,null,null,null,"N"]
[null,"services, such as gastric bypass or transplants, would not be considered a Tiered Network for the purposes of this report."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Copays","index":37,"n_rows":37,"n_cols":14,"rows_kept":37,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Copays",null,null,null,null,null,null,null,null,null,null,"Example:"]
[]
[null,"PCP Office Visit Copay",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for copays:"]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to General"]
[null,"Dollar amount of the PCP office visit copay for services within network."]
[null,"If this service has no cost sharing, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,10]
[null,"If this service does not have a copay but is subject to the deductible and coinsurance, input \"D/C\".",null,null,null,null,null,null,null,null,null,null,null,20]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier.",null,null,null,null,null,null,null,null,null,null,null,25]
[null,null,null,null,null,null,null,null,null,null,null,null,null,50]
[null,"Specialist Office Visit Copay",null,null,null,null,null,null,null,null,null,null,null,0]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"D/C"]
[null,"Dollar amount of the Specialist office visit copay for services within network."]
[null,"If this service has no cost sharing, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"If this service does not have a copay but is subject to the deductible and coinsurance, input \"D/C\"."]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier."]
[]
[null,"ED Copay"]
[null,"Description:"]
[null,"Dollar amount of the Emergency Department copay for services within network."]
[null,"If this service has no cost sharing, input 0 (zero)."]
[null,"If this service does not have a copay but is subject to the deductible and coinsurance, input \"D/C\"."]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier."]
[]
[null,"Outpatient Surgery Copay"]
[null,"Description:"]
[null,"Dollar amount of the Outpatient Surgery copay for services within network."]
[null,"If this service has no cost sharing, input 0 (zero)."]
[null,"If this service does not have a copay but is subject to the deductible and coinsurance, input \"D/C\"."]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier."]
[]
[null,"Inpatient Copay"]
[null,"Description:"]
[null,"Dollar amount of the Inpatient copay for services within network."]
[null,"If this service has no cost sharing, input 0 (zero)."]
[null,"If this service does not have a copay but is subject to the deductible and coinsurance, input \"D/C\"."]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier."]

{"sheet":"Deductible","index":38,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"In-Network Single Deductible",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the in-network, single tier type policy deductible.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for deductible:"]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"For FFS products, provide the overall cost sharing information."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,3000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,250]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,2000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,2500]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Coinsurance","index":39,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"In-Network Coinsurance",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Percentage figure of total plan and patient liability that the member is responsible for paying. ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for coinsurance:"]
[null,"For example, if the insurer pays 80% and the member pays 20%, a value of 0.20 should be reported.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form as a PERCENTAGE LIABILITY OF THE MEMBER, "]
[null,"If the plan has more than one co-insurance, use the highest level for services within network.",null,null,null,null,null,null,null,null,null,null,null,"NOT THE CARRIER"]
[null,"For Tiered Network HMO products, provide cost sharing for the most utilized tier."]
[null,"For FFS products, provide the overall cost sharing information.",null,null,null,null,null,null,null,null,null,null,null,0.1]
[null,"This value shall be in numeric decimal format with a value between 0 and 1.",null,null,null,null,null,null,null,null,null,null,null,0.2]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.4]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"OOP Max","index":40,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"In-Network Single Out of Pocket Maximum",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the maximum out of pocket expenses for services within network",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for out of pocket maximum:"]
[null,"for a single tier type policy. The out of pocket maximum should include any deductibles, where applicable.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"For Tiered Network HMO products, provide cost sharing for most utilized tier. For FFS products, provide "]
[null,"the overall cost sharing information. If there is no maximum, enter: 9,999,999.",null,null,null,null,null,null,null,null,null,null,null,5000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,2500]
[null,null,null,null,null,null,null,null,null,null,null,null,null,3500]
[null,null,null,null,null,null,null,null,null,null,null,null,null,9999999]
[null,null,null,null,null,null,null,null,null,null,null,null,null,400]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Pharmacy Deductibles","index":41,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Pharmacy Deductibles",null,null,null,null,null,null,null,null,null,null,"Example:"]
[]
[null,"Retail Pharmacy Single Deductible Generic",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for deductible:"]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"Dollar amount of the single tier type policy deductible for generic prescriptions"]
[null,"dispensed at an in-network retail pharmacy.",null,null,null,null,null,null,null,null,null,null,null,3000]
[null,"If there is no deductible, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,250]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1000]
[null,"Retail Pharmacy Single Deductible Brand Formulary",null,null,null,null,null,null,null,null,null,null,null,2000]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,0]
[null,"Dollar amount of the single tier type policy deductible for brand prescriptions on the formulary",null,null,null,null,null,null,null,null,null,null,null,2500]
[null,"dispensed at an in-network retail pharmacy."]
[null,"If there is no deductible, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[null,"Retail Pharmacy Single Deductible Brand Non-Formulary"]
[null,"Description:"]
[null,"Dollar amount of the single tier type policy deductible for brand prescriptions not on the formulary"]
[null,"dispensed at an in-network retail pharmacy."]
[null,"If there is no deductible, input 0 (zero)."]

{"sheet":"Pharmacy Copays","index":42,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Pharmacy Copays",null,null,null,null,null,null,null,null,null,null,"Example:"]
[]
[null,"Retail Pharmacy Copay Generic",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for copays:"]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric"]
[null,"Dollar amount of the copay for 30-day supply generic prescriptions"]
[null,"dispensed at an in-network retail pharmacy.",null,null,null,null,null,null,null,null,null,null,null,10]
[null,"If this service does not have a copay, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,20]
[null,null,null,null,null,null,null,null,null,null,null,null,null,25]
[null,"Retail Pharmacy Copay Brand Formulary",null,null,null,null,null,null,null,null,null,null,null,50]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,40]
[null,"Dollar amount of the copay for 30-day supply brand prescriptions on the formulary",null,null,null,null,null,null,null,null,null,null,null,0]
[null,"dispensed at an in-network retail pharmacy."]
[null,"If this service does not have a copay, input 0 (zero).",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[null,"Retail Pharmacy Copay Brand Non-Formulary"]
[null,"Description:"]
[null,"Dollar amount of the copay for 30-day supply brand prescriptions not on the formulary"]
[null,"dispensed at an in-network retail pharmacy."]
[null,"If this service does not have a copay, input 0 (zero)."]

{"sheet":"Actuarial Value","index":43,"n_rows":40,"n_cols":14,"rows_kept":40,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Actuarial Value",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Definition:"]
[null,"\n(a) “Actuarial Value” – For the purposes of this report, the Actuarial Value will be the ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for actuarial value:"]
[null,"Minimum Value measure as outlined in Section 1302 (d)(2)(C) of the Affordable Care Act.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form."]
[null,"Beginning in 2014, insurers and employers or unions with self insured plans must report"]
[null,"information to the IRS for each individual covered under a health insurance plan that provides ",null,null,null,null,null,null,null,null,null,null,null,0.49]
[null,"minimum coverage.  This information will be used by the IRS to determine whether individuals",null,null,null,null,null,null,null,null,null,null,null,0.61]
[null,"who purchase insurance on the exchanges will be eligible for a premium tax credit.  ",null,null,null,null,null,null,null,null,null,null,null,0.34]
[null,"The minimum value is defined as the percentage of the total allowed costs of benefits provided",null,null,null,null,null,null,null,null,null,null,null,0.35]
[null,"under a group health plan or health insurance coverage.  In accordance with the HHS regulations",null,null,null,null,null,null,null,null,null,null,null,0.12]
[null,"there are several options for determining the Minimum Value:",null,null,null,null,null,null,null,null,null,null,null,0.14000000000000001]
[]
[null,"Determine Minimum Value figure using the most recent version of the publically available Minimum "]
[null,"Value Calculator Excel model tool which can be downloaded from the following CMS website:",null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[null,"http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html"]
[null,"The Department of Health and Human Services has published guidance titled “Minimum Value Calculator Methodology” "]
[null,"which is also available on the website.  This guidance provides a detailed description of the data underlying the MV "]
[null,"Calculator and the calculator’s methodology."]
[]
[null,"Determine Minimum Value figure through any safe harbor established by HHS and IRS."]
[null,"If the plan design is incompatible with the Minimum Value Calculator or Safe Harbor Plan, the Minimum "]
[null,"Value figure may be determined through an actuarial certification from a member of the American Academy of Actuaries."]
[]
[null,"For each set of reported coverage options, e.g. each benefit plan, the carrier shall include on the Supplemental Report"]
[null,"the Minimum Value figure calculated in accordance to one of the three options mentioned above.  The Minimum Value Calculator "]
[null,"can be used for a wide variety of health plan designs; however, it is possible some benefit plan designs may not fit into the calculator. "]
[null,"In circumstances where this is the case, and the minimum value from the safe harbor or actuarial certification is not readily available,"]
[null,"a reasonable estimate based on comparison to similar plan designs may be reported in the Supplemental Report if the carrier receives"]
[null,"prior approval from the NHID."]
[]
[null,"If a method other than the Minimum Value Calculator is used, the alternate method that was used must be disclosed and described in"]
[null,"the notes section of the report submittal form along with documentation of prior approval, if applicable. "]
[]
[null,"Please do not provide figures based on the Actuarial Value Calculator.  The Actuarial Value Calculator uses different population "]
[null,"base and different continuance tables than the Minimum Value Calculator.  The results from the two calculators will be slightly "]
[null,"different.  For the purposes of this report and stable comparison across coverage segments and carriers, the Minimum Value"]
[null,"Calculator must be used."]
[]
[null,"This minimum value as described above is the “actuarial value”."]

{"sheet":"Exception Variables","index":44,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Exception Variables",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"The remaining variables are Exception Variables (EV).",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for Exception Variables:"]
[null,"Enter “NC” if the policy does not cover this service.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for codes and do not include spaces in (blank) fields."]
[null,"Enter \"DM\" if the policy generally covers this service, but does not meet the exact service description."]
[null,"Leave blank if this is a covered item.",null,null,null,null,null,null,null,null,null,null,null,"NC"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"DM"]
[null,"For a full list and description of covered services, please refer",null,null,null,null,null,null,null,null,null,null,null,"(blank)"]
[null,"to \"The State of New Hamphire Insurance Department Bulletin "]
[null,"Docket No.: INS No. 14-005-AB.\", dated February 7, 2014"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Specific Premium","index":45,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Specific Premium",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Premium for specific stop loss coverage provided in the reported calendar year.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for specific premium:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"“Premium” shall be calculated as “earned” premium, or the total amount of premium from",null,null,null,null,null,null,null,null,null,null,null,1569]
[null," policyholders to provide insurance coverage during the reporting year.  ",null,null,null,null,null,null,null,null,null,null,null,554]
[null,"Earned premium = premiums collected + change in due and uncollected – change in ",null,null,null,null,null,null,null,null,null,null,null,1506.88]
[null,"unearned and advance premium. If premium is collected prior to January 1, to provide",null,null,null,null,null,null,null,null,null,null,null,1353.5]
[null,"insurance coverage during the reported calendar year, than it must be included in this ",null,null,null,null,null,null,null,null,null,null,null,1008]
[null,"column. The Commissioner may approve the use of a reasonable proxy upon the ",null,null,null,null,null,null,null,null,null,null,null,2085]
[null,"carrier’s provision of documentation demonstrating that the use of the same does not ",null,null,null,null,null,null,null,null,null,null,null,4000]
[null,"materially distort the carrier’s data submission."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"Specific Claims","index":46,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Specific Claims",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Total specific stop loss claims incurred during the calendar year for which the supplemental",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for specific claims:"]
[null,"report is being made. Note that the claims are reported on an accrual basis for calendar year.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"If necessary, actuarial completion factors should be used to estimate incurred claims and",null,null,null,null,null,null,null,null,null,null,null,1220.07]
[null,"should be based on when the carrier extracts the data for the Supplemental Report.",null,null,null,null,null,null,null,null,null,null,null,161.15]
[null,null,null,null,null,null,null,null,null,null,null,null,null,50.36]
[null,"Incurred claims shall include:",null,null,null,null,null,null,null,null,null,null,null,30.22]
[null,"  - claims incurred during the reporting period and paid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,302.16000000000003]
[null,"  - claims incurred and reported during the reporting period but unpaid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,166.63]
[null,"  - claims incurred but not reported during the reporting period.",null,null,null,null,null,null,null,null,null,null,null,4000]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"Specific Attachment Point","index":47,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Specific Attachment Point",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the claim threshold level for an individual at which specific stop loss",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for specific attachment point:"]
[null,"coverage begins.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,25000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,100000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,75000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,80000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1000000]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Specific % Reimbursable","index":48,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Specific % Reimbursable",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Portion of the claims above the attachment point to be reimbursed by the stop loss coverage.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for specific % reimbursable:"]
[null,"This value shall be in numeric decimal format with a value between 0 and 1.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form."]
[null,"For example, if 80% of claims over the attachment point are covered by stop loss"]
[null,"insurance, enter 0.80."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.2]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.4]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Specific Reimbursement Max","index":49,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Specific Reimbursement Maximum",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the maximum amount reimbursable for a specific stop loss claim.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for specific reimbursement maximum:"]
[null,"If there is no maximum, enter: 9,999,999.  ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,100000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,250000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,500000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,9999999]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1000000]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Aggregate Premium","index":50,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Aggregate Premium",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Premium for aggregate stop loss coverage provided in the reported calendar year.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for aggregate premium:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"“Premium” shall be calculated as “earned” premium, or the total amount of premium from",null,null,null,null,null,null,null,null,null,null,null,1569]
[null,"policyholders to provide insurance coverage during the reporting year.  ",null,null,null,null,null,null,null,null,null,null,null,554]
[null,"Earned premium = premiums collected + change in due and uncollected – change in ",null,null,null,null,null,null,null,null,null,null,null,1506.88]
[null,"unearned and advance premium. If premium is collected prior to January 1, to provide",null,null,null,null,null,null,null,null,null,null,null,1353.5]
[null,"insurance coverage during the reported calendar year, then it must be included in this ",null,null,null,null,null,null,null,null,null,null,null,1008]
[null,"column. The Commissioner may approve the use of a reasonable proxy upon the ",null,null,null,null,null,null,null,null,null,null,null,2085]
[null,"carrier’s provision of documentation demonstrating that the use of the same does not ",null,null,null,null,null,null,null,null,null,null,null,4000]
[null,"materially distort the carrier’s data submission."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"Aggregate Claims","index":51,"n_rows":20,"n_cols":14,"rows_kept":20,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Aggregate Claims",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Total aggregate stop loss claims incurred during the calendar year for which the supplemental",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for aggregate claims:"]
[null,"report is being made. Note that the claims are reported on an accrual basis for calendar year.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"If necessary, actuarial completion factors should be used to estimate incurred claims and",null,null,null,null,null,null,null,null,null,null,null,1220.07]
[null,"should be based on when the carrier extracts the data for the Supplemental Report.",null,null,null,null,null,null,null,null,null,null,null,161.15]
[null,null,null,null,null,null,null,null,null,null,null,null,null,50.36]
[null,"Incurred claims shall include:",null,null,null,null,null,null,null,null,null,null,null,30.22]
[null,"  - claims incurred during the reporting period and paid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,302.16000000000003]
[null,"  - claims incurred and reported during the reporting period but unpaid prior to the report date",null,null,null,null,null,null,null,null,null,null,null,166.63]
[null,"  - claims incurred but not reported during the reporting period.",null,null,null,null,null,null,null,null,null,null,null,4000]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"Aggregate Attachment Point","index":52,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Aggregate Attachment Point",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Multiple of expected claims at which aggregate stop loss coverage begins.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for aggregate attachment point:"]
[null,"This value shall be in numeric decimal format with a value greater than 1.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form."]
[null,"For example, if the attachment point is 110% of expected claims, input 1.10."]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1.05]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1.1000000000000001]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1.25]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1.2]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Aggregate % Reimbursable","index":53,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Aggregate % Reimbursable",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Portion of the claims above the attachment point to be reimbursed by the aggregate stop loss coverage.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for aggregate % reimbursable:"]
[null,"This value shall be in numeric decimal format with a value between 0 and 1.",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form."]
[null,"For example, if 80% of claims over the attachment point are covered by stop loss"]
[null,"insurance, enter 0.80."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.2]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.3]
[null,null,null,null,null,null,null,null,null,null,null,null,null,0.4]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Aggregate Reimbursement Max","index":54,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Aggregate Reimbursement Maximum",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the maximum amount reimbursable under aggregate coverage.",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for aggregate reimbursement maximum:"]
[null,"If there is no maximum, enter: 9,999,999.  ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,100000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,250000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,500000]
[null,null,null,null,null,null,null,null,null,null,null,null,null,9999999]
[null,null,null,null,null,null,null,null,null,null,null,null,null,1000000]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Any other entry formats submitted are incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Medical","index":55,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Medical",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Do Medical claims apply toward the stop loss limit?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Medical:"]
[null,"Input \"Y\" if yes, \"N\" if no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Pharmacy","index":56,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Pharmacy",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Do Pharmacy claims apply toward the stop loss limit?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Pharmacy:"]
[null,"Input \"Y\" if yes, \"N\" if no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Dental","index":57,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Dental",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Do Dental claims apply toward the stop loss limit?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Dental:"]
[null,"Input \"Y\" if yes, \"N\" if no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Vision","index":58,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Vision",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Do Vision claims apply toward the stop loss limit?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Vision:"]
[null,"Input \"Y\" if yes, \"N\" if no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Disability","index":59,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Disability",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Do Disability claims apply toward the stop loss limit?",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for Disability:"]
[null,"Input \"Y\" if yes, \"N\" if no.",null,null,null,null,null,null,null,null,null,null,null,"Please use ALL CAPS for the following codes."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Y"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"These are the only entries that should be in this field."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Anything else submitted is incorrect and the NHID will request a data resubmission from the carrier."]

{"sheet":"Instructions End>","index":60,"n_rows":3,"n_cols":2,"rows_kept":3,"cut":false,"hidden":false,"merged":[]}
[]
[]
[null,"This tab was intentionally left blank. "]