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{"sheet":"Transmittal","index":0,"n_rows":50,"n_cols":10,"rows_kept":50,"cut":false,"hidden":false,"merged":[[10,1,10,6],[0,0,0,6],[1,1,1,6],[2,1,2,6],[3,1,3,6],[4,1,4,6],[5,1,5,6],[6,1,6,6],[7,1,7,6],[8,1,8,6],[9,1,9,6],[27,0,28,0],[29,1,29,6],[29,7,29,12],[30,0,32,0],[11,1,11,6],[12,1,12,6],[13,1,13,6],[14,1,14,6],[15,1,15,6],[24,0,25,0],[23,1,23,6],[23,7,23,12]]}
["Enter Data in the shaded areas only"]
["Field Name","Data Entry"]
["Company Code"]
["Company Name"]
["Reporting Year"]
["Date Fiscal Year Ends"]
["Contact Person Information"]
["  First Name"]
["  Last Name"]
["  Mailing Address Line 1"]
["  Mailing Address Line 2"]
["  Mailing Address City"]
["  Mailing Address 2-Letter State Abbreviation"]
["  Mailing Zip Code"]
["  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"]
["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,"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"]
["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,"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"]
[]
["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":51,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Coverage Type","Plan Type","Market Category Code","Policyholder Geographic Location","HDHP","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 Premium","Total Claims","Claims Incurred and Paid","Claims Incurred and Unpaid","Other Payments and Credits","Member Responsibility","Grandfathered Indicator","Deductible","Co-Insurance","Copay","Out-of-Pocket Maximum","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","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":"Notes","index":3,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Data Reconciliation","index":4,"n_rows":75,"n_cols":54,"rows_kept":75,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Summary from Main Data",null,null,null,null,null,null,null,null,"Summary from Main Data",null,null,null,null,null,null,null,null,"Summary from Main Data",null,null,null,null,null,null,null,null,"Summary from Main Data",null,null,null,null,null,null,null,null,"Summary from Limited Data",null,null,null,null,null,null,null,null,"Summary from Limited Data"]
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[]
[]
[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\")",{"$f":"SUM(C5:C7)","v":0},"Part 1 Other Indicators, Line 4 Member Months, Individual",null,null,null,{"$f":"+D38-(F38+H38)","v":0},{"$f":"IF(AND((F38+H38)=0,D38=0),0,IF((F38+H38)=0,1,I38/(F38+H38)))","v":0},0.01]
[null,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",{"$f":"SUM(C8:C11)","v":0},"Part 1 Other Indicators, Line 4 Member Months, Small Group",null,null,null,{"$f":"+D39-(F39+H39)","v":0},{"$f":"IF(AND((F39+H39)=0,D39=0),0,IF((F39+H39)=0,1,I39/(F39+H39)))","v":0},0.01]
[null,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",{"$f":"SUM(C12:C13)","v":0},"Part 1 Other Indicators, Line 4 Member Months, Large Group",null,null,null,{"$f":"+D40-(F40+H40)","v":0},{"$f":"IF(AND((F40+H40)=0,D40=0),0,IF((F40+H40)=0,1,I40/(F40+H40)))","v":0},0.01]
[null,"Self-Insured","\"Main Data\", where Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",{"$f":"SUM(D8:E13)","v":0},"Part 1 Other Indicators, Line 4 Member Months, Uninsured Plans",null,null,null,{"$f":"+D41-(F41+H41)","v":0},{"$f":"IF(AND((F41+H41)=0,D41=0),0,IF((F41+H41)=0,1,I41/(F41+H41)))","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\")",{"$f":"+SUM(L5:L7)","v":0},"Part 1, Line 1.1 Health premiums earned, Individual",null,null,null,{"$f":"+D45-(F45+H45)","v":0},{"$f":"IF(AND((F45+H45)=0,D45=0),0,IF((F45+H45)=0,1,I45/(F45+H45)))","v":0},0.01]
[null,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",{"$f":"SUM(L8:L11)","v":0},"Part 1, Line 1.1 Health premiums earned, Small Group",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,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",{"$f":"SUM(L12:L13)","v":0},"Part 1, Line 1.1 Health premiums earned, Large Group",null,null,null,{"$f":"+D47-(F47+H47)","v":0},{"$f":"IF(AND((F47+H47)=0,D47=0),0,IF((F47+H47)=0,1,I47/(F47+H47)))","v":0},0.01]
[]
[null,"Total Claims","Supplemental Report",null,"Supplemental Health Care Exhibit",null,"Adjustments to SHCE Values (if needed)",null,"Remaining Difference","% Difference","% Tolerance","Explanation of Differences More Than +/- % Tolerance"]
[null,null,"Description","Value","Description","Value","Description","Value"," "," "," "," "]
[null,"Individual","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"IND\", \"FCH\", \"GCV\")",{"$f":"+SUM(U5:U7)","v":0},"Part 1, Line 5 Total incurred claims, Individual",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,"Small Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",{"$f":"SUM(U8:U11)","v":0},"Part 1, Line 5 Total incurred claims, Small Group",null,null,null,{"$f":"+D52-(F52+H52)","v":0},{"$f":"IF(AND((F52+H52)=0,D52=0),0,IF((F52+H52)=0,1,I52/(F52+H52)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Large Group","\"Main Data\", where Coverage Type = \"UND\" and Market Category Code in (\"GLG1\", \"GLG2\")",{"$f":"SUM(U12:U13)","v":0},"Part 1, Line 5 Total incurred claims, Large Group",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"]
[]
[]
[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\")",{"$f":"SUM(C5:C7)+SUM(AV5:AV7)","v":0},"where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"IND\", \"FCH\", \"GCV\")",null,null,null,{"$f":"+D65-(F65+H65)","v":0},{"$f":"IF(AND((F65+H65)=0,D65=0),0,IF((F65+H65)=0,1,I65/(F65+H65)))","v":0},0.01]
[null,"Small Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",{"$f":"SUM(C8:C11)+SUM(AV8:AV11)","v":0},"where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GSA\")",null,null,null,{"$f":"+D66-(F66+H66)","v":0},{"$f":"IF(AND((F66+H66)=0,D66=0),0,IF((F66+H66)=0,1,I66/(F66+H66)))","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\")",{"$f":"SUM(C12:C13)+SUM(AV12:AV13)","v":0},"where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"GLG1\", \"GLG2\")",null,null,null,{"$f":"+D67-(F67+H67)","v":0},{"$f":"IF(AND((F67+H67)=0,D67=0),0,IF((F67+H67)=0,1,I67/(F67+H67)))","v":0},0.01]
[null,"Self-Insured","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",{"$f":"SUM(D8:E13)+SUM(AW8:AX13)","v":0},"where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE in (\"ASW\", \"ASO\"), PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\")",null,null,null,{"$f":"+D68-(F68+H68)","v":0},{"$f":"IF(AND((F68+H68)=0,D68=0),0,IF((F68+H68)=0,1,I68/(F68+H68)))","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\")",{"$f":"SUM(AD5:AD7)+SUM(AM5:AM7)","v":0},"Total medical and pharmacy paid claims for members where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"IND\", \"FCH\", \"GCV\")",null,null,null,{"$f":"+D72-(F72+H72)","v":0},{"$f":"IF(AND((F72+H72)=0,D72=0),0,IF((F72+H72)=0,1,I72/(F72+H72)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Small Group","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type = \"UND\" and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\")",{"$f":"SUM(AD8:AD11)+SUM(AM8:AM11)","v":0},"Total medical and pharmacy paid claims for members where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GSA\")",null,null,null,{"$f":"+D73-(F73+H73)","v":0},{"$f":"IF(AND((F73+H73)=0,D73=0),0,IF((F73+H73)=0,1,I73/(F73+H73)))","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\")",{"$f":"SUM(AD12:AD13)+SUM(AM12:AM13)","v":0},"Total medical and pharmacy paid claims for members where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE = \"UND\", PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\") and MKTCATCDE in (\"GLG1\", \"GLG2\")",null,null,null,{"$f":"+D74-(F74+H74)","v":0},{"$f":"IF(AND((F74+H74)=0,D74=0),0,IF((F74+H74)=0,1,I74/(F74+H74)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]
[null,"Self-Insured","Sum of \"Main Data\" and \"Limited Data\"\nwhere Coverage Type in (\"ASW\", \"ASO\") and Market Category Code in (\"GS1\", \"GS2\", \"GS3\", \"GS4\", \"GLG1\", \"GLG2\")",{"$f":"SUM(AE8:AF13)+SUM(AN8:AO13)","v":0},"Total medical and pharmacy paid claims for members where HAS_MEDICAL_Coverage = \"Y\", USEFLAG in (0, 9), member age less than 65, XTYPE in (\"ASW\", \"ASO\"), PRODUCT in (\"EP\", \"HM\", \"IN\", \"PR\", \"PS\")",null,null,null,{"$f":"+D75-(F75+H75)","v":0},{"$f":"IF(AND((F75+H75)=0,D75=0),0,IF((F75+H75)=0,1,I75/(F75+H75)))","v":0},"5% if Member Months < 100,000\n2% if Member Months >= 100,000"]

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[null,{"$f":"C3&\"_\"&D3","v":"0_0"},0,0,0,0,0,0,null,null,{"$f":"L3&\"_\"&M3","v":"0_0"},{"$f":"INDIRECT(\"'Limited Data'!\"&P3)","v":0},{"$f":"INDIRECT(\"'Limited Data'!\"&Q3)","v":0},{"$f":"INDIRECT(\"'Limited Data'!\"&V3)","v":0},{"$f":"INDIRECT(\"'Limited Data'!\"&S3)","v":0},"A3","C3","L3","N3","O3","P3","K3"]
[null,"0_0",{"$f":"INDIRECT(\"'Main Data'!\"&P4)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&Q4)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&R4)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&S4)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&T4)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&U4)","v":0},null,null,"0_0",{"$f":"INDIRECT(\"'Limited Data'!\"&P4)","v":0},0,0,0,"A4","C4","L4","N4","O4","P4","K4"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A5","C5","L5","N5","O5","P5","K5"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A6","C6","L6","N6","O6","P6","K6"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A7","C7","L7","N7","O7","P7","K7"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A8","C8","L8","N8","O8","P8","K8"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A9","C9","L9","N9","O9","P9","K9"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A10","C10","L10","N10","O10","P10","K10"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A11","C11","L11","N11","O11","P11","K11"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A12","C12","L12","N12","O12","P12","K12"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A13","C13","L13","N13","O13","P13","K13"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A14","C14","L14","N14","O14","P14","K14"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A15","C15","L15","N15","O15","P15","K15"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A16","C16","L16","N16","O16","P16","K16"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A17","C17","L17","N17","O17","P17","K17"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A18","C18","L18","N18","O18","P18","K18"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A19","C19","L19","N19","O19","P19","K19"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A20","C20","L20","N20","O20","P20","K20"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A21","C21","L21","N21","O21","P21","K21"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A22","C22","L22","N22","O22","P22","K22"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A23","C23","L23","N23","O23","P23","K23"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24","C24","L24","N24","O24","P24","K24"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A25","C25","L25","N25","O25","P25","K25"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A26","C26","L26","N26","O26","P26","K26"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A27","C27","L27","N27","O27","P27","K27"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A28","C28","L28","N28","O28","P28","K28"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A29","C29","L29","N29","O29","P29","K29"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A30","C30","L30","N30","O30","P30","K30"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A31","C31","L31","N31","O31","P31","K31"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A32","C32","L32","N32","O32","P32","K32"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A33","C33","L33","N33","O33","P33","K33"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A34","C34","L34","N34","O34","P34","K34"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A35","C35","L35","N35","O35","P35","K35"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A36","C36","L36","N36","O36","P36","K36"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A37","C37","L37","N37","O37","P37","K37"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A38","C38","L38","N38","O38","P38","K38"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A39","C39","L39","N39","O39","P39","K39"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A40","C40","L40","N40","O40","P40","K40"]
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[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A44","C44","L44","N44","O44","P44","K44"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A45","C45","L45","N45","O45","P45","K45"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A46","C46","L46","N46","O46","P46","K46"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A47","C47","L47","N47","O47","P47","K47"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A48","C48","L48","N48","O48","P48","K48"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A49","C49","L49","N49","O49","P49","K49"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A50","C50","L50","N50","O50","P50","K50"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A51","C51","L51","N51","O51","P51","K51"]
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[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24938","C24938","L24938","N24938","O24938","P24938","K24938"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24939","C24939","L24939","N24939","O24939","P24939","K24939"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24940","C24940","L24940","N24940","O24940","P24940","K24940"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24941","C24941","L24941","N24941","O24941","P24941","K24941"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24942","C24942","L24942","N24942","O24942","P24942","K24942"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24943","C24943","L24943","N24943","O24943","P24943","K24943"]
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[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24945","C24945","L24945","N24945","O24945","P24945","K24945"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24946","C24946","L24946","N24946","O24946","P24946","K24946"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24947","C24947","L24947","N24947","O24947","P24947","K24947"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24948","C24948","L24948","N24948","O24948","P24948","K24948"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24949","C24949","L24949","N24949","O24949","P24949","K24949"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24950","C24950","L24950","N24950","O24950","P24950","K24950"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24951","C24951","L24951","N24951","O24951","P24951","K24951"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24952","C24952","L24952","N24952","O24952","P24952","K24952"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24953","C24953","L24953","N24953","O24953","P24953","K24953"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24954","C24954","L24954","N24954","O24954","P24954","K24954"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24955","C24955","L24955","N24955","O24955","P24955","K24955"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24956","C24956","L24956","N24956","O24956","P24956","K24956"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24957","C24957","L24957","N24957","O24957","P24957","K24957"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24958","C24958","L24958","N24958","O24958","P24958","K24958"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24959","C24959","L24959","N24959","O24959","P24959","K24959"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24960","C24960","L24960","N24960","O24960","P24960","K24960"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24961","C24961","L24961","N24961","O24961","P24961","K24961"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24962","C24962","L24962","N24962","O24962","P24962","K24962"]
[null,{"$f":"C24963&\"_\"&D24963","v":"0_0"},0,0,0,0,0,0,null,null,{"$f":"L24963&\"_\"&M24963","v":"0_0"},0,{"$f":"INDIRECT(\"'Limited Data'!\"&Q24963)","v":0},{"$f":"INDIRECT(\"'Limited Data'!\"&V24963)","v":0},{"$f":"INDIRECT(\"'Limited Data'!\"&S24963)","v":0},"A24963","C24963","L24963","N24963","O24963","P24963","K24963"]
[null,"0_0",{"$f":"INDIRECT(\"'Main Data'!\"&P24964)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&Q24964)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&R24964)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&S24964)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&T24964)","v":0},{"$f":"INDIRECT(\"'Main Data'!\"&U24964)","v":0},null,null,"0_0",{"$f":"INDIRECT(\"'Limited Data'!\"&P24964)","v":0},0,0,0,"A24964","C24964","L24964","N24964","O24964","P24964","K24964"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24965","C24965","L24965","N24965","O24965","P24965","K24965"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24966","C24966","L24966","N24966","O24966","P24966","K24966"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24967","C24967","L24967","N24967","O24967","P24967","K24967"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24968","C24968","L24968","N24968","O24968","P24968","K24968"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24969","C24969","L24969","N24969","O24969","P24969","K24969"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24970","C24970","L24970","N24970","O24970","P24970","K24970"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24971","C24971","L24971","N24971","O24971","P24971","K24971"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24972","C24972","L24972","N24972","O24972","P24972","K24972"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24973","C24973","L24973","N24973","O24973","P24973","K24973"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24974","C24974","L24974","N24974","O24974","P24974","K24974"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24975","C24975","L24975","N24975","O24975","P24975","K24975"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24976","C24976","L24976","N24976","O24976","P24976","K24976"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24977","C24977","L24977","N24977","O24977","P24977","K24977"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24978","C24978","L24978","N24978","O24978","P24978","K24978"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24979","C24979","L24979","N24979","O24979","P24979","K24979"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24980","C24980","L24980","N24980","O24980","P24980","K24980"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24981","C24981","L24981","N24981","O24981","P24981","K24981"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24982","C24982","L24982","N24982","O24982","P24982","K24982"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24983","C24983","L24983","N24983","O24983","P24983","K24983"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24984","C24984","L24984","N24984","O24984","P24984","K24984"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24985","C24985","L24985","N24985","O24985","P24985","K24985"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24986","C24986","L24986","N24986","O24986","P24986","K24986"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24987","C24987","L24987","N24987","O24987","P24987","K24987"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24988","C24988","L24988","N24988","O24988","P24988","K24988"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24989","C24989","L24989","N24989","O24989","P24989","K24989"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24990","C24990","L24990","N24990","O24990","P24990","K24990"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24991","C24991","L24991","N24991","O24991","P24991","K24991"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24992","C24992","L24992","N24992","O24992","P24992","K24992"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24993","C24993","L24993","N24993","O24993","P24993","K24993"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24994","C24994","L24994","N24994","O24994","P24994","K24994"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24995","C24995","L24995","N24995","O24995","P24995","K24995"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24996","C24996","L24996","N24996","O24996","P24996","K24996"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24997","C24997","L24997","N24997","O24997","P24997","K24997"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24998","C24998","L24998","N24998","O24998","P24998","K24998"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A24999","C24999","L24999","N24999","O24999","P24999","K24999"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A25000","C25000","L25000","N25000","O25000","P25000","K25000"]
[null,"0_0",0,0,0,0,0,0,null,null,"0_0",0,0,0,0,"A25001","C25001","L25001","N25001","O25001","P25001","K25001"]

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[null,"This tab was intentionally left blank.  Instructions begin on the next tab."]

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[]
[]
[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 and limited data collection worksheet called \"Main Data\" and the \"Limited Data\". Instructions for other portions "]
[null,null,"of the Supplemental Report can be found on the NHID's website in the document, \"The State of New Hamphire Insurance Department"]
[null,null,"Bulletin Docket No.: INS No. 08-001-AB\", dated May 3, 2013."]
[]
[null,null,"The Main Data Collection"]
[null,null,"The main data collection worksheet shall be called ‘”Main Data”.   The first row of the Main Data worksheet shall contain the "]
[null,null,"required data fields.  Subsequent rows shall contain the data prescribed.  The data must be provided at the most"]
[null,null,"specific level 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”.   The first row of the Limited Data worksheet shall contain"]
[null,null,"the required data fields.  Subsequent rows shall contain the data prescribed.  The data must be "]
[null,null,"provided at the most specific level in order to accurately recognize 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,"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. 08-001-AB,\" dated May 3, 2013."]
[]
[null,null,"Changes in Requirements"]
[null,"-","Data will now be reported in two separate data collections: (1) the Main Data Collection for policies with a NH situs and (2) the Limited "]
[null,null,"Data Collection for policies without a NH situs.  Descriptions of the two data collections are found below in the “Tabulation Methods and Issues” "]
[null,null,"section and separate report specifications have been provided for each in Appendix A."]
[null,"-","An indicator for Healthy Kids business is now included in the “State, Federal, or Municipal Account” field."]
[null,"-","New data fields have been added for “Claims Incurred and Paid”, “Claims Incurred and Unpaid”, “Other Payments”, “Member Responsibility”,"]
[null,null," and “Grandfathered Indicator”."]
[null,"-","“Market Category Code” no longer includes “GSA” as an available value. For qualified association trusts, the group size will be assigned based on "]
[null,null,"the subgroups within the association."]
[null,"-","Excel Template now includes an automated flagging process for data verification to assist carriers in ensuring data submitted complies with "]
[null,null,"requirements described in this bulletin by checking for invalid codes and null entries where possible."]
[null,"-"," Excel Template includes a section for data reconciliation to other data sources to support consistent reporting practices."]
[null,"-","An additional template and instructions will be provided for the September 15th, 2013 data collection (see \"Due Date\" section for additional details)."]
[]
[]
[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, 2013, shall summarize the carrier’s business for the preceding"]
[null,null,"calendar year, ending on December 31, 2012."]
[]
[null,null,"Additionally, a second supplemental report will be required to be submitted by September 15, 2013 for the 2012 reporting year to support changes"]
[null,null,"in the data being requested. Two reports are necessary due to the analysis of changes from one year to the next that is performed within the "]
[null,null,"Supplemental Report. A subsequent bulletin will be issued detailing the additional changes to the data requirements for the second "]
[null,null,"supplemental report submission."]
[]
[null,null,"This annual reporting requirement shall continue in perpetuity unless and until explicit revocation by the NHID.  For future years, the revised format"]
[null,null,"for reporting to be used for the special September 15, 2013 data collection 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. "]
[null,null,"Incomplete or non-compliant filings on July 15 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, for filing an incomplete supplemental report, or for filing a "]
[null,null,"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."]

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[]
[]
[null,null,"Tabulation Methods and Issues"]
[null,null,"Data shall be tabulated in two separate, mutually exclusive data collections: (1) the Main Data collection"]
[null,null,"and (2) the Limited Data collection. The Main Data collection shall include data for all members who "]
[null,null,"receive services under a policy (whether individual or employer-sponsored) with a New Hampshire "]
[null,null,"situs or through a contract with a New Hampshire situs issued by a third party administrator. The"]
[null,null,"Limited Data collection shall include data for all New Hampshire residents, or members who have"]
[null,null,"a work location in New Hampshire (e.g. an out-of-state employer with a branch location in New "]
[null,null,"Hampshire), with a policy that does not have a New Hampshire situs. The carrier/TPA shall submit"]
[null,null,"data for all members who are employed at the New Hampshire branch location. The following chart "]
[null,null,"provides a visual description of the two data collections:"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[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,"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, or does not"]
[null,null,"meet the coverage definition provided in Attachment A, submit “NC” in the"]
[null,null,"appropriate field for that policy. Do NOT substitute field requirements with \"Y\", \"N\","]
[null,null,"\"NA\", or anything not specified in the reporting requirement.  Do not change column "]
[null,null,"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’."]
[]
[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 shall provide"]
[null,null,"data at the most detailed level at which the carrier keeps data. For this example,"]
[null,null,"the number of certificate holders, e.g. employees, and the number of covered lives"]
[null,null,"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."]
[]
[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 2012_Jul.xlsm. "]
[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 other carriers shall create a workbook using the Supplemental Report Excel"]
[null,null,"Template. 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. "]
[]
[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":9,"n_rows":32,"n_cols":14,"rows_kept":32,"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.",null,null,null,null,null,null,null,null,null,null,null,"UND"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"ASW"]
[null,"Attachment B-1",null,null,null,null,null,null,null,null,null,null,null,"ASO"]
[null,"All coverage type character codes are exactly three characters. Carriers shall use",null,null,null,null,null,null,null,null,null,null,null,"STL"]
[null,"the codes listed herein.",null,null,null,null,null,null,null,null,null,null,null,"STN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"MCD"]
["-","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,"OTH"]
[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,"These are the only entries that should be in this field."]
[null,"of ASW.",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."]
[]
["-","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":10,"n_rows":22,"n_cols":14,"rows_kept":22,"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,null,null,null,null,null,null,null,null,null,null,null,null,"POS"]
[null,"Attachment B-2",null,null,null,null,null,null,null,null,null,null,null,"PPO"]
[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,"EPO"]
[null,"codes listed herein.",null,null,null,null,null,null,null,null,null,null,null,"FFS"]
[]
["-","FFS: For indemnity-type plans, with no managed care features, carriers shall use a code"]
[null,"of FFS, (Fee-for-Service).",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."]
["-","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."]
[]
["-","HMO: For Health Maintenance Organizations managed care plans, carriers shall use a"]
[null,"code of HMO."]

{"sheet":"Market Category","index":11,"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":12,"n_rows":184,"n_cols":14,"rows_kept":184,"cut":false,"hidden":false,"merged":[[26,2,29,2]]}
[]
[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,"County Codes"]
[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,"zip code to county code"]
[null,"(Zip code(s) must be "]
[null,"provided to the NHID)"]
[]
[]
[null,"Note:  The above codes should be assigned based on the location of the policyholder (not the member).  "]
[null,"Non-NH policyholder data (with County Code of “Y”) shall be reported on the Limited Data tab and all other data "]
[null,"shall be reported on the Main Data tab."]
[]
[]
[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":"Y or N - Columns","index":13,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[[8,2,8,9]]}
[]
[null,"HDHP, Qualified Association Trust, Professional Employer Organization, HealthFirst,",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null," and Grandfathered Indicator"]
[null,"Description:",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for columns E-H and T:"]
[null,"HDHP","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,"Please use ALL CAPS for the following codes."]
[null,"Qualified Association Trust","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,"Y"]
[null,"Professional Employer Organization","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,"N"]
[null,"HealthFirst","Are the data for a HealthFirst product(s)? Input \"Y\" for yes, \"N\" for no. "]
[null,"Grandfathered Indicator","Is this health coverage plan Grandfathered per the ACA definition? Input “Y” for Grandfathered plans or “N” for Non-Grandfathered plans."]
[]
[]
[]
[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":"State or Municipal","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 or municipal:"]
[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":"Policyholder Months","index":15,"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 policy holder 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":16,"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":17,"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":"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 the data is reported for.",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 reporting data for)"]
[]
[]
[]
[]
[]
[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":"Total Premium","index":19,"n_rows":32,"n_cols":14,"rows_kept":32,"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, than 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,"Third Party Administrators shall calculate earned premium by aggregating the total "]
[null,"funds collected from contracted accounts to provide for all claims and expenses",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,"associated with the administration of the employer’s benefit plan.  These funds "]
[null,"include provisions for claims (net of stop-loss recoveries), administration, premium "]
[null,"for stop-loss coverage, profit margins, commissions, wellness programs, "]
[null,"network fees, and disease management programs."]
[]
[null,"Definition:",null,null,null,null,null,null,null,null," "]
[null,"“Premium” shall be calculated as “earned” premium, or the total amount of premium from "]
[null,"policyholders to provide insurance coverage during the reporting year.  "]
[null,"Earned premium = premiums collected + change in due and uncollected"]
[null,"     – change in unearned and advance premium."]
[null," If premium is collected prior to January 1, to provide insurance coverage during the "]
[null,"reported calendar year, than it must be included in this column. The Commissioner "]
[null,"may approve the use of a reasonable proxy upon the carrier’s provision of documentation "]
[null,"demonstrating that the use of the same does not materially distort the carrier’s data submission.  "]
[null,"For Third Party Administrators, premium shall mean the funds collected from contracted"]
[null,"accounts to provide for all claims and expenses associated with the administration of "]
[null,"the employer’s benefit plan.  Additional detail regarding how to report Premium can be"]
[null,"found in Attachment A.   "]

{"sheet":"Claims Columns","index":20,"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 based 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 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 acceptable 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. 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.  "]
[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":"Deductible","index":21,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Deductible",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the policy deductible. If the plan has more than one deductible, use the highest level",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct data entries for deductible:"]
[null,"for medical services within network. If there are separate deductibles for prescription drugs, ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value"]
[null,"hospitalization, or out-of-network services, do not include here. Dollar amounts refer to"]
[null,"individual coverage, not family coverage.",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":22,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Co-Insurance",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. This value shall be in",null,null,null,null,null,null,null,null,null,null,null,"NOT THE CARRIER"]
[null,"numeric format."]
[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,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":"Copays","index":23,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Copay",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"Dollar amount of the highest office visit copay for services within network.  ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for coinsurance:"]
[null,"If there is no copay, enter zero.",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,10]
[null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,50]
[null,null,null,null,null,null,null,null,null,null,null,null,null,40]
[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":24,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"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  ",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,"network. 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,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":"Actuarial Value","index":25,"n_rows":25,"n_cols":15,"rows_kept":25,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Actuarial Value",null,null,null,null,null,null,null,null,null,null,"Example:"]
[null,"Description:"]
[null,"A factor representative of the relative value of the benefits being reported against a standardized ",null,null,null,null,null,null,null,null,null,null,null,"The ensuing are correct examples of data entries for actuarial value:"]
[null,"set of benefits.  RSA 420-G:4, I(c) requires carriers to calculate a health coverage plan rate for ",null,null,null,null,null,null,null,null,null,null,null,"Please format entries to Numeric Value in decimal form."]
[null,"each of their coverage options.  The Reinsurance Pool has developed four benefit plans that"]
[null," ceding carriers must use to adjudicate claims, an indemnity plan, a PPO plan, a POS plan ",null,null,null,null,null,null,null,null,null,null,null,0.49]
[null,"and an HMO plan.  Carriers shall calculate the health coverage plan rate for these four plans, ",null,null,null,null,null,null,null,null,null,null,null,0.61]
[null,"using the PPO plan for EPO products.  Then for each set of reported coverages, e.g. each ",null,null,null,null,null,null,null,null,null,null,null,0.34]
[null,"benefit plan, the carrier shall include in this field the ratio of the health coverage plan rate ",null,null,null,null,null,null,null,null,null,null,null,0.35]
[null,"for that coverage to the health coverage plan rate for the appropriate plan developed ",null,null,null,null,null,null,null,null,null,null,null,0.12]
[null,"by the reinsurance pool.  This ratio is the “actuarial value .” ",null,null,null,null,null,null,null,null,null,null,null,0.14000000000000001]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"NA","for Stop Loss Policies"]
[null,"For stop-loss coverage, a value of “NA” should be entered."]
[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,"Definition:"]
[null,"(a) \"Actuarial value\" - For purposes of this report, each carrier shall calculate a factor representative of the "]
[null,"relative value of the benefits being reported against a standardized set of benefits.  RSA 420-G:4, I(c) "]
[null,"requires carriers to calculate a health coverage plan rate for each of its coverage options.  The "]
[null,"Reinsurance Pool has developed four benefit plans that ceding carriers must use to adjudicate claims,"]
[null,"an indemnity plan, a PPO plan, a POS plan and an HMO plan.  Carriers shall calculate the health "]
[null,"coverage plan rate for these four plans, using the PPO plan for EPO products.  Then for each set of "]
[null,"reported coverage, e.g. each benefit plan, the carrier shall include on its supplement report the ratio"]
[null,"of the health coverage plan rate for that coverage to the health coverage plan rate for the appropriate"]
[null,"plan developed by the reinsurance pool.  This ratio is the “actuarial value.”"]

{"sheet":"Covered Services Columns Z-AY","index":26,"n_rows":14,"n_cols":14,"rows_kept":14,"cut":false,"hidden":false,"merged":[]}
[]
[null,"Covered Services",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 covered services:"]
[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," Leave blank if this is a covered item."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"NC"]
[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. 08-001-AB.\", dated May 3, 2013 "]
[]
[]
[]
[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":"Technical Troubleshooting","index":27,"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:"]
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[null,"1.","Check the data on both the 'Main Data' and 'Limited 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."]
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[null,"2a.","If you receive this error, make sure Macros are ENABLED in the workbook."]
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[null,"2b.","First, if this displays under the 'Ribbon'"]
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[null,"2c.","Click on 'Options' and select 'Enable this Content' and hit 'OK'."]
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[null,"3a.","If you do not see this dialog, Macros may be disabled already. If this is the case, select the 'Wheel'"]
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[null,"3b.","And select 'Excel Options' from the Menu."]
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[null,"3c.","Select 'Trust Center'"]
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[null,"3d.","And click on 'Trust Center Settings'"]
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[null,"3e.","Go to 'Macro Settings'"]
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[null,"3f.","And 'Enable All Macros' - Note, this could potentially cause unsafe behavior."]
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[null,"3g.","If you are unsure of this option, select 'Disable all macros with notification'"]
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[null,"3h.","Then select 'OK' and exit back to the Workbook."]
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[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."]
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[null,"4.","If you still are experiencing issued with the macro, please contact Tyler Brennan at Tyler.Brannen@ins.nh.gov"]

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