Tip: Identifying Members in Qualified Health Plans, the Arkansas Private Option or Arkansas Works

Use the HIOS ID (ME992).  A valid HIOS ID is 16 characters (some submitting entities place values in this field that are not 16 characters wide).   The presence of a 16 character wide HIOS ID indicates that the member is enrolled in a QHP plan.   NOTE:  The HIOS ID is not included in a standard data pull.  It is available for an additional fee.

To understand the components of a HIOS ID, see below.  HOIS IDs ending in 32 or 36 represent Arkansas Private Option or Arkansas Works populations.

HIOS ID value component definitions:

• A 16-digit field that serves as a unique plan identifier for a plan and a given variant
• Structured as follows: [HIOS ID][State][Product Iteration][Plan Iteration][Variant]
  • [HIOS ID] = 5-digit HIOS ID
  • [STATE] = 2-digit state code, such as CA, TX, AL, etc. (does include District of Columbia as DC)
  • [Product Iteration] = 3-digit number to indicate a unique product designation
  • [Plan Iteration] = 4-digit number to indicate a unique plan designation
  • [Variant] = 2-digit number to indicate cost-sharing variant and on/off Exchange
    • 00 = Plan sold off the Exchange [Maximum Out of Pocket (MOOP) values not required for these plans]
    • 01-06 = Plan sold on the Exchange in a given CSR variant
    • 31-36 = On-Exchange Medicaid expansion plans (Arkansas and Iowa only)
  • The 14-digit version of this ID is often referred to as the “Standard Component ID” or SCID