Appendix N: HIOS ID Value Component Definitions

The following tables provide valid value component requirements requirements for ME992 and MC992. The 16-byte value (CMS field name INSRNC_PLAN_ID) is comprised of several components, each with a specific meaning. All components should be provided in the field.

HIOS_ID or INSRNC_PLAN_ID

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] = Five (5) digit HIOS ID
- [STATE] = Two (2) digit state code, such as AR, CA, TX, AL, etc. (does include District of Columbia as DC)
- [Product Iteration] = Three (3) digit number to indicate a unique product designation
- [Plan Iteration] = Four (4) digit number to indicate a unique plan designation
- [Variant] = Two (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
UPDATE (2025-06-10):
- Updated Code and Variant definitions
  - CSR Variant (digits 15 and 16 of the HIOS ID) definitions/explanations See table below.
  - Arkansas Medicaid specific variants
    - <=20% FPL (32 CSR Variant)
    - 20%-40% FPL (21 CSR Variant)
    - 40%-60% FPL (41 CSR Variant)
    - 60%-80% FPL (61 CSR Variant)
    - 80%-100% FPL (81 CSR Variant)
    - 100%-120% FPL (11 CSR Variant)
    - 120%-138% FPL (36 CSR Variant)

Plan ID with variant	Plan ID	Variant	Meaning of variant	Who crafted this variant?	Variant meant for which consumer?	Available in the marketplace ?

Plan ID with variant	Plan ID	Variant	Meaning of variant	Who crafted this variant?	Variant meant for which consumer?	Available in the marketplace ?
62141AR0080101-00	62141AR0080101	00	Standard Silver Off Exchange Plan	CMS	Consumers outside the marketplace	N
62141AR0080101-01	62141AR0080101	01	Standard Silver On Exchange Plan	CMS	above 250% FPL	Y
62141AR0080101-02	62141AR0080101	02	Zero Cost Sharing Plan Variation (100% AV)	CMS	Native Americans below 300%FPL	Y
62141AR0080101-03	62141AR0080101	03	Limited Cost Sharing Plan Variation	CMS	Native Americans above 300%FPL	Y
62141AR0080101-04	62141AR0080101	04	73% AV Level Silver Plan	CMS	200-250	Y
62141AR0080101-05	62141AR0080101	05	87% AV Level Silver Plan	CMS	150-200	Y
62141AR0080101-06	62141AR0080101	06	94% AV Level Silver Plan	CMS	139-150	Y
62141AR0080101-32*	62141AR0080101	32	Zero Cost Sharing Plan Variation in Expanded Medicaid	Arkansas (to mimic -02 CMS Equivalent)	0-100% FPL ARHOME beneficiaries	N
62141AR0080101-36*	62141AR0080101	36	Limited Cost Sharing Plan Variation in Expanded Medicaid	Arkansas (to mimic -06 CMS Equivalent)	101-138% FPL ARHOME beneficiaries	N


Plan ID 62141AR0080101 a silver plan marketed as "Ambetter Balanced Care 4" is used as an example
*Note: Arkansas Medicaid split the two original two variant levels with the 0-138% FPL bands into seven bands around PY2023. The practical operational issues with such tight segmentation is that something like a $160 change in a beneficiary's annual income may change one's level- and that could be a frequent occurrence. The seven levels are described in the "Arkansas Medicaid variants" below.