U.S. Department of Health & Human Services

Health Plan Transparency in Coverage Public Use Files

Name: Health Plan Transparency in Coverage Public Use Files
Creator: U.S. Department of Health & Human Services

This Public Use File compiles information about health insurance plan operations in accordance with Transparency in Coverage regulations. Each record details issuer and plan-level claims, appeals, and active URLs for plans participating in the Exchange in 2020.

Example records

Namebrand	Stateaddress	Websitewebsite	Unnamed: 2registration	Unnamed: 3status	Unnamed: 4status	Unnamed: 5registration	Unnamed: 6classification	Unnamed: 7classification	Unnamed: 8classification	Unnamed: 10quantity	Unnamed: 11quantity
Blue Cross Blue Shield of Wyoming	WY	https://www.bcbswy.com/QHPTransparency	11269	No	No	11269WY0170016	QHP	PPO	Silver	935848	121710
Blue Cross Blue Shield of Wyoming	WY	https://www.bcbswy.com/QHPTransparency	11269	No	No	11269WY0170015	QHP	PPO	Silver	935848	121710
Blue Cross Blue Shield of Wyoming	WY	https://www.bcbswy.com/QHPTransparency	11269	No	No	11269WY0070026	QHP	PPO	Bronze	935848	121710

Use cases

Health Insurer KYB Verification for Provider Network Contracting

A hospital system's contracting team vetting a new payer relationship checks whether the insurer is an active Exchange participant, confirms its state of operation, and validates its official web presence before negotiating reimbursement terms.

NameStateUnnamed: 2Unnamed: 3Website

Carrier Claims Performance Benchmarking for Stop-Loss Underwriting

A stop-loss reinsurer evaluating exposure on a self-funded employer group uses plan-level claims volume and payment rate data to benchmark the primary carrier's historical claims behavior before pricing excess-loss coverage.

NameUnnamed: 5Unnamed: 7Unnamed: 10Unnamed: 14

Market Entry Sizing for Health Tech Sales Teams

A health technology vendor mapping addressable markets by state identifies which insurers operate Exchange plans, what plan types they offer, and how many covered lives or claims they process, to prioritize outreach to high-volume carriers.

NameStateUnnamed: 6Unnamed: 7Unnamed: 10