| BHP Enrollment Data | |||||||||||||||||||||||
| Enrollee Information | Coverage Information | Plan Information | |||||||||||||||||||||
| Personal Identifier | Date of Birth | County Name | County FIPS Code | American Indian or Alaska Native | Household Size | Household Annual Income | Number of BHP Enrollees in Household | Family Identifier | Jan-15 | Feb-15 | Mar-15 | Apr-15 | May-15 | Jun-15 | Jul-15 | Aug-15 | Sep-15 | Oct-15 | Nov-15 | Dec-15 | Plan Name | Plan Issuer | Plan ID |
| 111111111 | 1/1/1970 | AAA | 01001 | N | 3 | $35,000 | 1 | 111111111 | 1 | 1 | 1 | XXX | XXX | 111 | |||||||||
| 222222222 | 1/1/1966 | BBB | 01003 | N | 1 | $20,000 | 1 | 222222222 | 0 | 0 | 1 | YYY | YYY | 222 | |||||||||
| 333333333 | 1/1/1975 | CCC | 01005 | N | 2 | $25,000 | 2 | 333333333 | 1 | 1 | 1 | ZZZ | ZZZ | 333 | |||||||||
| 444444444 | 1/1/1976 | CCC | 01005 | N | 2 | $25,000 | 2 | 333333333 | 1 | 1 | 1 | ZZZ | ZZZ | 333 | |||||||||
| 555555555 | 1/1/1980 | DDD | 01007 | Y | 1 | $20,000 | 1 | 555555555 | 1 | 1 | 1 | XXX | XXX | 111 | |||||||||
| Data Element | Required Specification | State Specificiation |
| Personal identifier | SSN, unique Marketplace identification number, or unique Medicaid identification number | |
| Date of Birth | mm/dd/yyyy | |
| County Name | county name as text | |
| County FIPS Code | numeric FIPS code | |
| American Indian or Alaska Native | Y=Yes, N=No | |
| Household Size | number of people in household | |
| Household Annual Income | annual MAGI household income | |
| Number of BHP Enrollees in Household | number of BHP enrollees | |
| Family Identifier | personal identifier of head of household | |
| Coverage Month | 1=enrolled, 0=not enrolled | |
| Plan Name | plan name as text | |
| Plan Issuer | plan issuer as text | |
| Plan ID | HIOS ID or NAIC-issued Payer ID |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |