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Readme file for
AIS’s Directory of Health Plans: 2015 (“the Product”)
This product was purchased under a single-user license agreement and may be used by only one person in your organization.
Visit http://aishealth.com/support/directoryhealthplans for more information.
SYSTEM REQUIREMENTS
CD-ROM drive or USB drive (depending on which version purchased)
Other requirements depend on the file format selected by the user. This disk/flash drive includes the data
in MS Access, MS Excel and CSV formats.
SINGLE-USER LICENSE AGREEMENT
AIS’s Directory of Health Plans: 2015 (“the Product”)
AIS grants to you the non-exclusive, limited right to use the Product to the extent provided in this
paragraph. You may install the Product, in any format, on a single, individual workstation in your
company, on a disk drive that is not accessible to other employees via a network. The data is licensed for
analysis by one employee at your company.
That employee may combine this raw data with other available database applications, may create reports
or analysis from the data, and may prepare mail-merge promotional pieces from the data. The employee
may distribute these resulting documents in a limited manner, in paper or PDF format, that ensures the
raw data cannot be accessed or manipulated by other employees via a network or other electronic
means.
You may not copy, install, make available or otherwise use the Product on the Internet or the World Wide
Web. This database may not be resold, licensed, or leased to another party. Publication of this data for
sale or distribution outside of your own company is prohibited.
Customer understands and agrees that the Product consists of intellectual property belonging to AIS and
that the Product is protected by copyright and may be subject to trademark and other laws. Customer
agrees not to make any use of the Product not specifically authorized by this License Agreement or by the
copyright laws of the United States.
It is your responsibility to make certain that no unlicensed users obtain access to the Product, and you are
responsible for ensuring that each licensed user understands and abides by the terms and conditions of
this License Agreement.
Subject to these limitations, the user may use the Product in any manner you deem helpful in connection
with your business, including by printing paper copies of all or portions of the Product, but in all cases only
for internal use within your company. You may not transfer this license to anyone without AIS’s written
permission. Your use of this information is subject to all the terms and conditions of this License
Agreement.
To upgrade to a Multi-User License that will provide you with the right to install and use this data on your
network and/or additional workstations within your organization, please contact Bailey Sterrett, Sales
Director, at (202) 775-9008 ext. 3034 or [email protected], or contact
[email protected] for more information on licenses.
CONTENTS
This disk/flash drive contains the following files:
LicenseAgreement2015.rtf – this single-user license agreement covers use of the data contained on this
CD/flash drive.
DirectoryofHealthPlans2015.pdf — The electronic version of “AIS’s Directory of Health Plans: 2015,” as it
appears in the printed publication.
Methodology.rtf – information about AIS’s survey data process and research methodology for each
chapter
FieldList2015.pdf – A complete list of all the fields that are in the tables of this edition, and guidelines on
how to use the data for market share analysis.
EnrollmentFieldHierarchyandComparison.xlsx — Explanation of which enrollment fields total to equal
which enrollment fields in the MCO/HealthPlans data sets. Plus guidance on new fields for the 2015
edition, and guidance on 2014 edition field names and definitions as compared to 2013 edition field
names and definitions, and how to map/compare enrollment data from prior editions to the current
edition.
TableRelationships.pdf — Graphical schema of the relational database as it is shipped in MS Access.
PubNotes.rtf – Output by record (MCO ID#) of all publication notes included in the printed book, for
customers using the Excel files, because some notes are too long for the Excel format and are truncated.
HealthPlansbyState2015.pdf –2,182-page report features a section for each state in alphabetical order,
and each section includes the full listing of each MCO operating in that state. MCOs with operations in
multiple states are repeated in each state.
Data Folders:
Excel Files (files in MS Excel spreadsheets)
1-Health Plans.xlsx
--Intro
--1.1-HealthPlans--the entire data set of health plans from this edition (513 records)
--1.2-CommercialRiskPlans--all data fields for just those companies that have
commercial operations (filtered view of 1.1) (236 records)
--1.3-MedicarePlans--all data fields for just those companies that have Medicare
operations (filtered view of 1.1) (294 records)
--1.4-MedicaidPlans--all data fields for just those companies that have managed
Medicaid operations (filtered view of 1.1) (180 records)
--1.5-RollupByParent--all enrollment data from the Health Plans data set, rolled up to
the largest national parent entity applicable (461 records)
--1.6-Appendix--the entire data set of new health plans listed in the Appendix of this
edition. These plans do not have any membership data yet. (7 records)
2-State Enrollment Data.xlsx
--Intro
--2.1-StateTotals--state population, total enrollment identified in state, and penetration
(% of population identified as covered) (52 records)
--2.2-MCOStateEnrollment--state-level enrollment for all states for all health plans listed
in Chapters 2 and 3 (2,097 records)
3-Mailing Lists.xlsx
--Intro
--3.1-HealthPlanContacts--contact information for health insurance executives listed in
Chapter 2 of "AIS's Directory of Health Plans: 2015" (4,940 records)
--3.2-AppendixContacts--contact information for health insurance executives listed in
the Appendix section of "AIS's Directory of Health Plans: 2015" (26 records)
--3.3-SubsidiaryContacts--contact information for health insurance executives listed in
4.2-SubsidiaryAddendum on this CD (3,156 records)
--3.4-ParentContacts—contact information for Parent Organizations listed in the 4.1ParentOrganizations on this CD (33 records)
--3.5-PDPContacts--contact information for Medicare Part D stand-alone PDP plans
listed in Chapter 4 of "AIS's Directory of Health Plans: 2015" (61 records)
--3.6-ACOContacts--contact information for executives involved in Accountable Care
Organizations listed in Chapter 6 of "AIS's Directory of Health Plans: 2015" (301 records)
4-Supplemental Addendum.xlsx
--Intro
--4.1-ParentOrganizations--corporate contact information and enrollment totals for
health plans that are represented by two or more listings in Chapter 2 (33 records)
--4.2-SubsidiaryAddendum--contact information and enrollment data at the local
subsidiary level, where available from government agencies and other public sources
(2,432 records)
--4.3-MedicareDirectory—contains the CMS Directory of Medicare Advantage Plans (MA
and MA-PD) for December 2014 (661 records)
--4.4-PDPPlans--the Medicare PDP Plan contact and enrollment data as of December
2014, as published in Chapter 4 (61 records)
--4.5-MedicareContractLinks--the linking data between AIS's MCO ID and CMS Medicare
Contract Numbers for Part C and D plans as of December 2014 (725 records)
--4.6-ACOs--the full data set of Health Plan/ACO arrangements listed in Chapter 6 (311
records)
5-Sector Enrollment Breakdowns.xlsx
--Intro
5.1-Commercial--state-level Commercial Risk enrollment for all plans (784 records)
5.2-Medicare--state-level Medicare enrollment for all plans (787 records)
5.3-MedicaidHMO--state-level Medicaid HMO enrollment for all plans (279 records)
5.4-MedicaidFFS--Medicaid fee-for-service enrollment for all state agencies (53 records)
5.5-All--state-level enrollment for Commercial, Medicare, Medicaid and Medicaid FFS
enrollment for all plans, plus ASO enrollment where estimates were possible (1,514
records)
MS Access Files
AISHealthPlanData2015.accdb—relational database with the following Tables and Queries:
1-1-Health Plans (Table)
1-2-CommercialRiskPlans (Query)
1-3-MedicarePlans (Query)
1-4-MedicaidPlans (Query)
Publication Notes (Query)
1-5-RollupByParent (Table)
1-6-Appendix (Table)
2-1-StateTotals (Table)
2-2-MCOStateEnrollment (Table)
3-1-HealthPlanContacts (Table)
3-2-Appendix Contacts (Table)
3-3-SubsidiaryContacts (Table)
3-4-ParentContacts (Table)
3-5-PDPContacts (Table)
3-6-ACOContacts (Table)
4-1-ParentOrganizations (Table)
4-2-SubsidiaryAddendum (Table)
4-3-MedicareDirectory (Table)
4-4-PDPPlans (Table)
4-5-MedicareContractLinks (Table)
4-6-ACOs (Table)
5-Sector and State (Table)
5-1-CommercialRiskByState (Query)
5-2-MedicareByState (Query)
5-3-MedicaidHMObyState (Query)
5-4-MedicaidFFSbyState (Query)
5-5-ASOestimatesbyState (Query)
Table Relationships (Report)
CSV Files (files exported to CSV format from Excel)
NOTE: See Excel files’ Intro pages for specific information about data sets
1.1-HealthPlans
1.2-CommercialRiskPlans
1.3-MedicarePlans
1.4-MedicaidPlans
1.5-RollupByParent
1.6-Appendix
2.1-StateTotals
2.2-MCOStateEnrollment
3.1-HealthPlanContacts
3.2-AppendixContacts
3.3-SubsidiaryContacts
3.4-ParentContacts
3.5-PDPContacts
3.6-ACOContacts
4.1-ParentOrganizations
4.2-SubsidiaryAddendum
4.3-MedicareDirectory
4.4-PDPPlans
4.5MedicareContractLinks
4.6-ACOs
5.1-Commercial
5.2-Medicare
5.3-MedicaidHMO
5.4-MedicaidFFS
5.5-All
METHODOLOGY
The scope of this database covers all known health insurers serving enrollees as of Dec. 31, 2014.
Inclusion in the database is not optional. Entities are listed when determined by AIS to meet the criteria.
AIS does not accept payment for listings.
All companies were surveyed by AIS staff researchers between Oct. 1, 2014, and Dec. 31, 2014.
Organizations were contacted individually and offered options to fill out an online or paper survey, or to
provide information via email, fax, mail or telephone interviews. Data provided directly by companies via
survey is deemed the most accurate and up-to-date information on that company. For companies that do
not return a survey, or where blanks are left on responses, researchers endeavor to complete the record
through other means.
Survey data are audited against public records as available. Discrepancies are usually found to be
due to differences in definition and/or timing. AIS researchers work closely with health plan sources to
identify the specific enrollees that should be attributed to the categories as defined in the AIS database
for the most accurate comparison.
For listed entities that prefer for AIS to obtain enrollment data from publicly available sources,
fully insured commercial enrollment is from third-quarter 2014 state insurance department filings.
Medicare enrollment was updated from the November 2014 Centers for Medicare and Medicaid Services
(CMS) records. Medicaid enrollment, when not provided by the company, was collected from state
Medicaid agency reports ranging in date from September to December 2014, whichever was the latest
available report as of Dec. 31. Data from company websites, SEC filings, company press releases and news
reports were referenced.
Data in Chapter 4, Medicare Part D Directory and Enrollment, is from the Centers for Medicare
and Medicaid Services’ (CMS) PDP Directory and Enrollment reports dated December 2014.
Data in Chapter 5, Health Plan Participation in Health Insurance Exchanges, comes from the AIS
Health Plan survey. Health Insurance Exchange enrollment is included for insurers that participated in
public exchanges for the 2014 plan year. This figure is a subset of the total commercial risk enrollment
and represents enrollment in individual and/or small-group products. Most figures in this field were
obtained directly from the company; some figures were released by the applicable state exchange. In
some instances, AIS estimated the number, in collaboration with the health plan, based on the increase in
the individual and/or small-group figure from the 2014 edition. Note: Chapter 5 lists public insurance
exchange participation for the 2015 plan year. Any enrollment figures for public exchange enrollment in
this publication represent data from the 2014 plan year.
Data in Chapter 6, Health Plan Participation in Accountable Care Organizations (ACOs) and Similar
Partnerships, was researched separately by AIS researchers based on news reports and company
announcements. Health plans were not asked about ACOs on the annual survey form.
Data for Chapter 7, NCQA Accreditation Status of U.S. Health Plans, was contributed by the
National Committee for Quality Assurance per agreement with AIS.
TECHNICAL SUPPORT
The database has been provided in three data formats for your convenience -- Access 2010, Excel 2010,
and CSV. If you are unable to use any of these file formats, please consult your local IT professional for
conversion.
Guidance from the Database Researchers and Editors on field definitions and how to use the tables
provided is available at http://aishealth.com/support/directoryhealthplans or by emailing
[email protected]. Support is available only to licensed users.
To upgrade to a Multi-User License that will provide you with the right to install and use this data on your
network and/or an unlimited number of additional workstations within your organization (for a one-time
fee of $7,775 minus the amount already paid for the single-user license), please contact Bailey Sterrett,
Sales Director, at (202) 775-9008 ext. 3034 or [email protected], or contact
[email protected] for more information on licenses.