Equal to the number of covered subscribers divided by the number Group Subscriber Count, Average: of employers. If multiple group IDs are maintained for a given employer, please use the number of employers in this calculation and not the number of group IDs. For a given employer, the number of covered subscribers should be the average for the calendar year. Market Sector: Market Sector includes four employer-sponsored plan categories, four direct-purchaser plan categories, and two categories for state and federal employee plans, as described below. Market Category Description Sector Health insurance plans purchased by individuals either directly No from a payer or through the Massachusetts Health Connector Subsidy/Unknown without public subsidy. Health insurance plans purchased by individuals through the Massachusetts Health Connector and qualified for an Advance APTC Subsidy Only Premium Tax Credit (APTC) subsidy but not qualified for a Reduction (CSR) subsidy. Direct Health insurance plans purchased by individuals through the Purchasers APTC + CSR Massachusetts Health Connector and qualified for an Advance Subsidies Premium Tax Credit (APTC) subsidy and a Cost-Sharing Reduction (CSR) subsidy (ConnectorCare plans). Health insurance plans purchased by students through their school for primary, medical coverage. The ACA considers Student Health student health insurance purchasers individual, non-group purchasers. Fully-Insured: health insurance plans purchased through employer groups with 2-50 eligible enrollees, and that meet the definition of an Small Business or Group,” per “Eligible Massachusetts Division of Insurance Regulation 211 CMR 66.04, except as otherwise noted in the Massachusetts Division of Insurance Bulletin 2016-09. Includes any Small Groups that may Small Group have purchased health insurance through the Massachusetts Health Connector. Includes any Small Groups that may have purchased health insurance through an association. Non Fully-Insured: plans purchased through employer groups with 2-50 enrolled employees. Fully-Insured: health insurance plans purchased through employer groups with 51-100 enrolled employees, and those employer groups with fewer than 51 enrollees that would not otherwise meet the definition of a Small Group (e.g., an employer Mid-Size with 150 total employees but only 40 enrolled employees). Non Fully-Insured: plans purchased through employer groups with 51-100 enrolled employees. All: health insurance plans and non-fully insured plans purchased Large Group through employer groups with 101-499 enrolled employees. All: health insurance plans and non-fully insured plans purchased Jumbo Group through employer groups with 500+ enrolled employees.
Group Subscriber Count, Average: Equal to the number of covered subscribers divided by the number of employers. If multiple group IDs are maintained for a given employer, please use the number of employers in this calculation and not the number of group IDs. For a given employer, the number of covered subscribers should be the average for the calendar year. Market Sector: Market Sector includes four employer-sponsored plan categories, four direct-purchaser plan categories, and two categories for state and federal employee plans, as described below. Market Sector Category Description Direct Purchasers No Subsidy/Unknown Health insurance plans purchased by individuals either directly from a payer or through the Massachusetts Health Connector without public subsidy. APTC Subsidy Only Health insurance plans purchased by individuals through the Massachusetts Health Connector and qualified for an Advance Premium Tax Credit (APTC) subsidy but not qualified for a Reduction (CSR) subsidy. APTC + CSR Subsidies Health insurance plans purchased by individuals through the Massachusetts Health Connector and qualified for an Advance Premium Tax Credit (APTC) subsidy and a Cost-Sharing Reduction (CSR) subsidy (ConnectorCare plans). Student Health Health insurance plans purchased by students through their school for primary, medical coverage. The ACA considers student health insurance purchasers individual, non-group purchasers. Small Group Fully-Insured: health insurance plans purchased through employer groups with 2-50 eligible enrollees, and that meet the definition of an “Eligible Small Business or Group,” per Massachusetts Division of Insurance Regulation 211 CMR 66.04, except as otherwise noted in the Massachusetts Division of Insurance Bulletin 2016-09. Includes any Small Groups that may have purchased health insurance through the Massachusetts Health Connector. Includes any Small Groups that may have purchased health insurance through an association. Non Fully-Insured: plans purchased through employer groups with 2-50 enrolled employees. Mid-Size Fully-Insured: health insurance plans purchased through employer groups with 51-100 enrolled employees, and those employer groups with fewer than 51 enrollees that would not otherwise meet the definition of a Small Group (e.g., an employer with 150 total employees but only 40 enrolled employees). Non Fully-Insured: plans purchased through employer groups with 51-100 enrolled employees. Large Group All: health insurance plans and non-fully insured plans purchased through employer groups with 101-499 enrolled employees. Jumbo Group All: health insurance plans and non-fully insured plans purchased through employer groups with 500+ enrolled employees.
2017-Premiums-Data-Submission-Manual.docx