CurrentMedicarePolicy N/A

HHS risk adjustment transfer simulation (BY2020 EDGE data) — Summary Report

Summary report of HHS-run transfer simulations estimating the combined impact of proposed risk adjustment model specification changes using issuers' BY2020 EDGE data; affects issuers of risk-adjustment-covered plans and state market risk pools.

Policy Summary

PayerMedicare

PolicyHHS risk adjustment transfer simulation (BY2020 EDGE data) — Summary Report

Policy CodePolicy N/A

Change TypeInformational simulation summary (no coverage change)

Effective DateN/A

Next Review DateN/A

Key ActionIssuers were required to execute EDGE server commands within designated timeframes to run simulations and receive plan-level reports.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4simulation iterations

BY2020EDGE data year

50+DCstates with credible participation

565total issuers

5HIOS IDs excluded

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Simulation Scope and Data Structure

Appendix B data excerpt

Excerpt from Appendix B (Issuer-Level Simulated Transfer Estimates) showing sample issuer rows with HIOS, company name, state, and simulated transfer amounts for SIM1–SIM4. This excerpt preserves issuer identifiers, names, state, and dollar transfer amounts (negative values shown in parentheses).

75091, HIOS INSURANCE COMPANY NAME = (name suppressed in excerpt). 75091, SIM1 = ($994,078.05). 75091, SIM2 = ($679,410.01). 75091, SIM3 = ($738,875.34). 75091, SIM4 = ($558,819.98).

76962, HIOS INSURANCE COMPANY NAME = ConnectiCare, Inc.. 76962, STATE = CT. 76962, SIM1 = ($32,199,672.97). 76962, SIM2 = ($35,024,625.85). 76962, SIM3 = ($35,184,924.63). 76962, SIM4 = ($33,893,222.03).

86545, HIOS INSURANCE COMPANY NAME = Anthem, Inc.. 86545, STATE = CT. 86545, SIM1 = $17,885,195.42. 86545, SIM2 = $19,321,504.90. 86545, SIM3 = $19,502,851.37. 86545, SIM4 = $17,729,819.29.

94815, HIOS INSURANCE COMPANY NAME = ConnectiCare, Inc.. 94815, STATE = CT. 94815, SIM1 = $15,308,555.51. 94815, SIM2 = $16,382,530.88. 94815, SIM3 = $16,420,948.53. 94815, SIM4 = $16,722,222.71.

78079, HIOS INSURANCE COMPANY NAME = CareFirst. 78079, STATE = DC. 78079, SIM1 = $9,784,472.97. 78079, SIM2 = $10,307,138.29. 78079, SIM3 = $10,110,986.57. 78079, SIM4 = $9,841,976.82.

86052, HIOS INSURANCE COMPANY NAME = CareFirst. 86052, STATE = DC. 86052, SIM1 = ($6,635,613.27). 86052, SIM2 = ($6,926,270.92). 86052, SIM3 = ($6,802,670.63). 86052, SIM4 = ($6,437,429.53).

11512, HIOS INSURANCE COMPANY NAME = Blue Cross Blue Shield of North Carolina. 11512, STATE = NC. 11512, SIM1 = $25,842,782.05. 11512, SIM2 = $27,931,073.53. 11512, SIM3 = $29,980,515.26. 11512, SIM4 = $27,392,179.97.

37900, HIOS INSURANCE COMPANY NAME = Bright Health Insurance Company. 37900, STATE = NC. 37900, SIM1 = ($36,911,237.07). 37900, SIM2 = ($38,827,147.57). 37900, SIM3 = ($39,646,127.40). 37900, SIM4 = ($38,317,609.97).

73943, HIOS INSURANCE COMPANY NAME = Cigna. 73943, STATE = NC. 73943, SIM1 = $3,421,766.68. 73943, SIM2 = $3,388,003.22. 73943, SIM3 = $3,079,495.02. 73943, SIM4 = $3,209,516.87.

77264, HIOS INSURANCE COMPANY NAME = Centene Corporation. 77264, STATE = NC. 77264, SIM1 = $7,646,688.36. 77264, SIM2 = $7,508,070.80. 77264, SIM3 = $6,586,117.18. 77264, SIM4 = $7,715,913.11.

37160, HIOS INSURANCE COMPANY NAME = Blue Cross Blue Shield of North Dakota. 37160, STATE = ND. 37160, SIM1 = $6,676,805.92. 37160, SIM2 = $7,038,640.75. 37160, SIM3 = $7,379,324.49. 37160, SIM4 = $7,445,315.63.

73751, HIOS INSURANCE COMPANY NAME = Medica Insurance Company. 73751, STATE = ND. 73751, SIM1 = (value omitted in excerpt).

46944, HIOS INSURANCE COMPANY NAME = Blue Cross Blue Shield of Alabama. 46944, STATE = AL. 46944, SIM1 = $48,480.53. 46944, SIM2 = $39,181.39. 46944, SIM3 = $33,084.25. 46944, SIM4 = $28,595.89.

73301, HIOS INSURANCE COMPANY NAME = Bright Health Insurance Company. 73301, STATE = AL. 73301, SIM1 = ($48,480.52). 73301, SIM2 = ($39,181.39). 73301, SIM3 = ($33,084.25). 73301, SIM4 = ($28,595.89).

13877, HIOS INSURANCE COMPANY NAME = Oscar Health. 13877, STATE = AZ. 13877, SIM1 = $159,322.66. 13877, SIM2 = $145,587.67. 13877, SIM3 = $146,400.83. 13877, SIM4 = $200,712.15.

53901, HIOS INSURANCE COMPANY NAME = Blue Cross Blue Shield of Arizona, Inc.. 53901, STATE = AZ. 53901, SIM1 = $16,554.09. 53901, SIM2 = $13,605.92. 53901, SIM3 = $13,818.37. 53901, SIM4 = ($41,418.97).

87247, HIOS INSURANCE COMPANY NAME = Bright Health Insurance Company. 87247, STATE = AZ. 87247, SIM1 = ($175,876.76). 87247, SIM2 = ($159,193.58). 87247, SIM3 = ($160,219.21). 87247, SIM4 = ($159,293.18).

10544, HIOS INSURANCE COMPANY NAME = Oscar Health. 10544, STATE = CA. 10544, SIM1 = ($2,629,258.67). 10544, SIM2 = ($3,131,367.05). 10544, SIM3 = ($3,127,264.08). 10544, SIM4 = (value omitted in excerpt).

58081, STATE = GA. 58081, SIM1 = ($2,668.09). 58081, SIM2 = ($3,689.96). 58081, SIM3 = ($3,632.58). 58081, SIM4 = ($4,301.04).

89942, HIOS INSURANCE COMPANY NAME = Kaiser Permanente. 89942, STATE = GA. 89942, SIM1 = $520,512.36. 89942, SIM2 = $511,614.78. 89942, SIM3 = $518,365.76. 89942, SIM4 = $599,636.86.

18350, HIOS INSURANCE COMPANY NAME = Hawaii Medical Service Association. 18350, STATE = HI. 18350, SIM1 = $0.00. 18350, SIM2 = $0.00. 18350, SIM3 = $0.00. 18350, SIM4 = $0.00.

93078, HIOS INSURANCE COMPANY NAME = Medica Insurance Company. 93078, STATE = IA. 93078, SIM1 = $0.00. 93078, SIM2 = $0.00. 93078, SIM3 = $0.00. 93078, SIM4 = $0.00.

26002, HIOS INSURANCE COMPANY NAME = SelectHealth. 26002, STATE = ID. 26002, SIM1 = $4,453.34. 26002, SIM2 = ($6,918.02). 26002, SIM3 = $23,272.48. 26002, SIM4 = ($42,589.11).

38128, HIOS INSURANCE COMPANY NAME = Montana Health Cooperative. 38128, STATE = ID. 38128, SIM1 = ($47,684.63). 38128, SIM2 = ($37,381.79). 38128, SIM3 = ($15,675.06). 38128, SIM4 = ($36,604.39).

60597, HIOS INSURANCE COMPANY NAME = PacificSource Health Plans. 60597, STATE = ID. 60597, SIM1 = ($33,201.57). 60597, SIM2 = ($37,641.67). 60597, SIM3 = ($39,214.13). 60597, SIM4 = (value omitted in excerpt).

88380, HIOS INSURANCE COMPANY NAME = Anthem, Inc.. 88380, STATE = VA. 88380, SIM1 = ($320,300.09). 88380, SIM2 = ($234,057.51). 88380, SIM3 = ($251,730.10). 88380, SIM4 = ($221,624.53).

95185, HIOS INSURANCE COMPANY NAME = Kaiser Permanente. 95185, STATE = VA. 95185, SIM1 = $185,755.20. 95185, SIM2 = $149,789.55. 95185, SIM3 = $139,301.99. 95185, SIM4 = $168,324.10.

13627, HIOS INSURANCE COMPANY NAME = Blue Cross Blue Shield of Vermont. 13627, STATE = VT. 13627, SIM1 = $4,225.04. 13627, SIM2 = $6,529.84. 13627, SIM3 = $6,105.50. 13627, SIM4 = $3,378.69.

77566, HIOS INSURANCE COMPANY NAME = MVP Health Plan, Inc.. 77566, STATE = VT. 77566, SIM1 = ($4,225.04). 77566, SIM2 = ($6,529.84). 77566, SIM3 = ($6,105.50). 77566, SIM4 = ($3,378.69).

14057, HIOS INSURANCE COMPANY NAME = PacificSource Health Plans. 14057, STATE = WA. 14057, SIM1 = ($137,746.76). 14057, SIM2 = ($181,442.85). 14057, SIM3 = ($186,225.94). 14057, SIM4 = ($152,067.44).

23371, HIOS INSURANCE COMPANY NAME = Kaiser Permanente. 23371, STATE = WA. 23371, SIM1 = $274,913.40. 23371, SIM2 = $282,489.96. 23371, SIM3 = $270,408.71. 23371, SIM4 = $247,981.67.

38498, HIOS INSURANCE COMPANY NAME = Premera Blue Cross. 38498, STATE = WA. (additional rows continue in full Appendix B).

Identifiers, Codes, and Simulation Columns

Sample HIOS Issuer Identifiersmixed

78079	CareFirst
30252	(example issuer)
16842	(example issuer)
38344	Premera Blue Cross
77963	Moda Health Plan, Inc.
46944	Blue Cross Blue Shield of Alabama
73301	Bright Health Insurance Company
37903	Centene Corporation
62141	Centene Corporation
76962	ConnectiCare, Inc.

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Issuer Participation and Deliverables

Documentation Required

Run required EDGE commands within designated timeframes

Issuers had to run specified EDGE server commands within set timeframes (July–October 2021) for the simulation to complete; HHS only provided state-level estimates where all credible issuers in that state market risk pool completed the required simulation activities.

Commands executed on issuers' EDGE servers beginning in July 2021 and ending in October 2021.
State estimates provided only if all credible issuers in the state market risk pool completed the simulation.

Note

Simulation results provided to issuers for information only

Plan-level (PLRS) and simulation reports were provided to participating issuers and HHS after each iteration, but results are informational only and not for rate setting.

HHS calculated issuers' Plan Liability Risk Score (PLRS) at the plan level and provided RATEE reports to issuers.
Estimated simulation results and plan-level risk score reports are for informational purposes only.

Terms and Abbreviations

PLRS

DefinitionPlan Liability Risk Score (PLRS)

Calculation levelPLRS is calculated at the plan level for each simulation iteration and provided to issuers in RATEE reports

Use in simulationHHS used simulated PLRS values to estimate transfers reported in Appendix A (SIM1–SIM4)

state payment transfer formula

DefinitionState payment transfer formula calculates payments and charges at the state market risk pool level prior to high-cost pool adjustments

Data dependencySimulations held other state payment transfer formula variables constant while isolating model specification changes using BY2020 EDGE data

Policy Summary

PayerMedicare

PolicyHHS risk adjustment transfer simulation (BY2020 EDGE data) — Summary Report

Policy CodePolicy N/A

Change TypeInformational simulation summary (no coverage change)

Effective DateN/A

Next Review DateN/A

Key ActionIssuers were required to execute EDGE server commands within designated timeframes to run simulations and receive plan-level reports.

SourceLink

On This Page

Documentation Required

Appendix A: state average risk scores and transfer estimates (SIM1–SIM4)

Appendix A contains state-by-state average risk scores and absolute value transfer amounts for each market risk pool across SIM1–SIM4 scenarios.

Includes Average Risk Score and Total Absolute Value Transfer Estimates by state and market risk pool for SIM1–SIM4.

Documentation Required

North Carolina: reported risk scores and transfer amounts

For North Carolina (Individual market): state average risk scores and absolute value transfer amounts are reported for SIM1–SIM4 (e.g., SIM1 risk score 1.480; SIM1 transfers $73.82 million).

NC Individual: SIM1 risk score = 1.480; SIM2 = 1.467; SIM3 = 1.488; SIM4 = 1.471.
NC Individual absolute value transfer amounts (in $ millions): SIM1 = $73.82; SIM2 = $77.65; SIM3 = $79.29; SIM4 = $76.64.

Documentation Required

Appendix B: issuer-level simulated transfer listings (SIM1–SIM4)

Appendix B provides issuer-level simulated transfer estimates (SIM1–SIM4) by HIOS issuer ID, issuer name, and state for market-level transfer modeling (Individual, Small Group, Catastrophic, merged pools).

Tables list HIOS ID, issuer name, state, and four simulated transfer estimates (SIM1–SIM4).
Amounts may be positive (net transfer in) or negative (net transfer out, shown in parentheses).

Documentation Required

Issuer-level simulated transfer estimates include HIOS ID + SIM1–SIM4

Appendix B rows include HIOS identifier, issuer name, state, and four simulated transfer estimate columns (SIM1–SIM4) for each issuer; examples show both positive and negative dollar amounts.

Each issuer row: HIOS ID, issuer name, STATE, SIM1, SIM2, SIM3, SIM4.
Examples include large positive and negative simulated transfer dollar amounts by issuer.

Documentation Required

Appendix B: issuer-specific simulated transfer data (examples)

Appendix B data entries show issuer-level simulated transfer estimates (SIM1–SIM4) for many issuers across states (examples: Blue Cross Blue Shield of North Carolina HIOS 11512; Bright Health Insurance Company HIOS 37900) with specific dollar values per scenario.

11512 (Blue Cross Blue Shield of North Carolina) listed with SIM1–SIM4 dollar amounts in Appendix B.
37900 (Bright Health Insurance Company) listed with negative SIM values across scenarios.

Documentation Required

ISSUER simulated transfer estimates include four scenario columns (SIM1–SIM4)

Issuer-level simulated transfer estimates include dollar values for each of SIM1–SIM4 per issuer; the appendix shows many issuer rows with four scenario columns (SIM1–SIM4) and indicates values can be positive or negative.

SIM1–SIM4 columns reported per issuer.
Parentheses indicate net negative simulated transfer values for that issuer in that scenario.

Documentation Required

Appendix B excerpts: multi-state issuer listings and zero-value entries

Appendix B excerpts list many issuer rows with HIOS IDs, issuer names, states, and SIM1–SIM4 amounts (examples across GA, HI, ID, MT, etc.), including zero-value rows for some issuers.

Some issuers show $0.00 for all SIM scenarios.
Examples span multiple states and issuers across the appendix.

Documentation Required

Issuer simulated transfers: wide variation and consistent row format

Appendix B excerpts provide issuer-level simulated transfer rows with HIOS ID, issuer name, state, and SIM1–SIM4 dollar estimates for multiple issuers; amounts can vary widely and include large positives and negatives.

Rows show large positive and large negative simulated transfer estimates per issuer and scenario.
Multiple entries for the same issuer across different chunks demonstrate consistency of the reporting format.

Documentation Required

Appendix B excerpt: example issuer SIM1–SIM4 values

Issuer-level simulated transfer estimates (excerpt) demonstrate the reporting format: each row contains HIOS issuer ID, insurer name, state, and four simulated transfer estimates (SIM1–SIM4) with specific dollar values.

Example: HIOS 11512 (BCBS NC) listed with SIM1 = $24,516,102.29; SIM2 = $27,001,236.18; SIM3 = $27,511,233.45; SIM4 = $25,752,390.85.
The appendix lists many issuer rows following this same structure.

Documentation Required

Issuer simulated transfer rows: HIOS ID + SIM1–SIM4 delivered to issuers

Appendix B rows list issuer HIOS IDs, insurer names, state, and four simulated transfer estimates (SIM1–SIM4) for each issuer; HHS provided these reports to issuers after each iteration.

Each row = HIOS issuer ID, insurer name, STATE, SIM1, SIM2, SIM3, SIM4.
Reports were delivered to issuers and HHS after each simulation iteration.

Documentation Required

Consistent reporting of issuer SIM1–SIM4 estimates across appendix excerpts

Appendix B excerpts consistently report issuer-level simulated transfer estimates (SIM1–SIM4) by HIOS ID, issuer name, and state; amounts are presented per issuer and scenario.

Multiple chunks show the same issuer-level SIM1–SIM4 reporting format.
Amounts may be presented as positive or negative dollar values.

Documentation Required

Table B.4: merged market risk pool issuer transfer estimates

Table B.4 presents estimated transfer amounts by issuer and market for the merged market risk pool, listing HIOS IDs, issuer names, state, and SIM1–SIM4 dollar estimates for each issuer.

Table B.4 is titled 'Estimated Transfer Amount by Issuer and Market, Merged Market Risk Pool'.
Table rows include HIOS ID, issuer name, STATE, and SIM1–SIM4 values.

Inclusion requirement

HHS provided state-level estimates only where all credible issuers in a state market risk pool completed the simulation

EDF

DefinitionEnrollment Duration Factor (EDF)

Proposed changeRevised adult EDFs would apply only to adult enrollees with ≥1 HCC and up to six months of enrollment (replacing 1–11 month linear EDFs)

Simulation effectAverage EDF coefficient increased to 2.04 under SIM4 reflecting the proposed EDF revision

Interacted HCC counts

DefinitionInteracted HCC counts: count-based factors that interact with specified severity and transplant HCCs

SpecificationAdds separate count factors for severity HCCs (1–10+ for adults; multiple groupings for children) to increase adjustments for enrollees with many payment HCCs

Transplant interactionFor transplant HCCs, adds count factors for adults (4–8+ payment HCCs) and for children (4+ payment HCCs); average transplant enrollee risk score change = +7.54 (SIM3→SIM4)

Average Risk Score

DefinitionAverage Risk Score: numeric risk score reported per state, market risk pool, and simulation scenario (SIM1–SIM4)

Reported valuesAppendix A lists state-level average risk scores for each SIM (examples: AK SIM1=1.316; MD SIM1=1.473)

PurposeUsed to compute state absolute value transfer amounts under each simulation scenario

Absolute Value Transfer Amounts

DefinitionAbsolute Value Transfer Amounts (in $ millions): monetary amounts representing transfers associated with state average risk scores under each simulation

UnitsValues in Appendix A are presented in $ millions per state and market risk pool (SIM1–SIM4)

ExampleNC, Individual: SIM1 transfer = $73.82 million; SIM3 = $79.29 million

Absolute Value Transfer Amounts

DefinitionAbsolute Value Transfer Amounts: dollar amounts (reported in $ millions) representing simulated transfers between issuers or risk pools under each SIM scenario

ScopeAppendix A and B present absolute transfer amounts by state/market pool and issuer-level dollar estimates respectively

Example valuesSC Individual SIM1 = $45.38 million; MA SIM4 = $0.26 million

State Average Risk Score

DefinitionState Average Risk Score: numeric risk score reported per state, market risk pool, and simulation scenario (SIM1–SIM4)

Example (NC)NC Individual: SIM1 = 1.480; SIM2 = 1.467; SIM3 = 1.488; SIM4 = 1.471

Reporting locationValues appear in Appendix A (Average Risk Score & Total Absolute Value Transfer Estimates)

Dollar amounts representing simulated transfers

DefinitionDollar amounts representing simulated transfers (issuer-level) shown as dollar estimates (positive or negative) for SIM1–SIM4

Appendix locationIssuer-level dollar amounts are reported in Appendix B (Table B.1–B.4) by HIOS ID, issuer name, state, and SIM1–SIM4

Example (issuer totals)HIOS 11512 (BCBS NC): SIM1 = $25,842,782.05; SIM4 = $27,392,179.97

Simulated average risk score

DefinitionSimulated average risk score for the state within a specified market risk pool and simulation scenario

ExampleMD Individual: SIM1 risk score = 1.473; SIM4 risk score = 1.489

Relation to transfersState average risk score drives the absolute value transfer amounts reported per SIM

Different simulated transfer scenarios per issuer

DefinitionDifferent simulated transfer scenarios per issuer (SIM1, SIM2, SIM3, SIM4)

MeaningSIM1=BY2020 baseline; SIM2=BY2021 models; SIM3=final BY2022 models; SIM4=proposed BY2022 models incorporating two-stage weighting, revised EDFs, and interacted HCC counts

Reported for each issuerAppendix B lists four simulated dollar estimates (SIM1–SIM4) for each issuer by HIOS ID and state

Issuer name and state

FieldIssuer name (HIOS INSURANCE COMPANY NAME)

FieldState (STATE) where the issuer is listed

Example11512 = Blue Cross Blue Shield of North Carolina (STATE = NC)

Four simulation scenarios producing transfer estimates

DefinitionFour simulation scenarios (SIM1–SIM4) producing transfer estimates (dollar amounts) for each issuer

SIM meaningsSIM1 = BY2020 baseline; SIM2 = BY2021 models (Version 07 HCCs); SIM3 = final BY2022 models; SIM4 = proposed BY2022 models (two-stage weighting, revised EDFs, interacted HCC counts)

PresentationAppendix B reports these four scenario dollar estimates per issuer row

Health Insurance Oversight System identifier for issuers

DefinitionHealth Insurance Oversight System identifier (HIOS) used to identify issuers in the tables

FormatNumeric HIOS IDs precede issuer name in Appendix B rows (e.g., 11512, 32225, 46944)

UseHIOS IDs link issuer rows to simulated SIM1–SIM4 dollar estimates in Appendix B and Table B.2–B.4

Simulation scenarios used to estimate transfer amounts

DefinitionSimulation scenarios used to estimate transfer amounts: SIM1, SIM2, SIM3, SIM4

DocumentationSIM definitions and modeling differences are described in Methodology and Iteration sections (SIM4 incorporates proposed BY2022 changes)

Reported per issuerEach issuer row in Appendix B contains dollar estimates for SIM1–SIM4

HIOS identifier

DefinitionHIOS identifier (numeric) shown before issuer name in Appendix B rows

Example32225 (Montana Health Cooperative), 11512 (Blue Cross Blue Shield of North Carolina)

RoleUsed to uniquely identify issuer records across tables and simulation outputs

Simulation scenarios representing alternative estimates

DefinitionSimulation scenarios represent alternative estimates (SIM1–SIM4) used to produce issuer-level transfer dollar estimates

InterpretationAmounts may be positive (net transfer in) or negative (net transfer out; shown in parentheses)

ExampleCareFirst HIOS 78079 SIM1=$9,784,472.97; SIM4=$9,841,976.82 (Appendix B excerpts)

Numeric identifier for the issuer (HIOS ID)

DefinitionNumeric HIOS ID uniquely identifying the issuer (HIOS ID)

UsageDisplayed in each issuer row and used to reference issuer-level SIM1–SIM4 dollar estimates

Example46944 = Blue Cross Blue Shield of Alabama (Table B.2 excerpt)

Simulated transfer estimate columns

DefinitionSimulated transfer estimate columns (SIM1, SIM2, SIM3, SIM4) reported per issuer

Column contentEach column contains a dollar estimate (may be positive or negative) representing that scenario's simulated transfer for the issuer

Appendix B formatAppendix B issuer rows list SIM1–SIM4 sequentially after HIOS ID, issuer name, and state

HIOS identifier used to identify insurers

DefinitionHIOS identifier used to identify insurers in Appendix B issuer tables

Examples11512 (BCBS NC), 32225 (Montana Health Cooperative), 23620 (UnitedHealth Group, MD)

PurposeEnables cross-referencing of issuer-level simulation outputs with issuer names and states

Simulation scenarios producing transfer dollar estimates

DefinitionSimulation scenarios producing transfer dollar estimates: SIM1, SIM2, SIM3, SIM4

Reporting noteFour scenario results are reported per issuer row in Appendix B and aggregated in Table B.4 for merged market pools

ExampleTX issuers show large magnitude SIM values across scenarios (e.g., HCSCs and Centene entries in Appendix B excerpts)

Negative simulated transfer

DefinitionNegative simulated transfer: negative dollar amounts indicate net transfer out for the issuer (shown in parentheses)

ExampleBright Health Insurance Company HIOS 37900 (NC): SIM1 = ($36,911,237.07) represents a net negative transfer

ReportingAppendix B uses parentheses to denote negative simulated transfer values in SIM columns

Simulated transfer estimate columns reported per issuer

DefinitionSimulated transfer estimate columns reported per issuer (SIM1–SIM4)

Per-row fieldsEach issuer row includes: HIOS ID, issuer name, STATE, SIM1, SIM2, SIM3, SIM4

Presentation noteSome issuers have $0.00 entries for one or more SIM columns in Appendix B excerpts

HIOS identifier

DefinitionHIOS identifier (numeric) shown before issuer name in Appendix B rows

Example73301, 13877, 53901 shown as leading identifiers in Table B.2 entries

ImportanceServes as the primary identifier for issuer-level simulated transfer rows

SIM1–SIM4

DefinitionSIM1–SIM4: four simulated transfer estimate scenarios reported for each issuer

RoleUsed to compare baseline BY2020, BY2021, final BY2022, and proposed BY2022 modeled transfers

DisplayEach issuer row in Appendix B lists SIM1, SIM2, SIM3, SIM4 dollar estimates; amounts can be positive or negative

SIM1–SIM4

DefinitionSIM1–SIM4: scenario columns showing alternative simulated transfer dollar estimates per issuer

ExampleHIOS 11512 (BCBS NC) SIM1=$25,842,782.05; SIM3=$29,980,515.26; SIM4=$27,392,179.97

InterpretationDifferences across SIM columns reflect changes in model specifications and recalibration updates used in each iteration

Merged Market Risk Pool

DefinitionMerged Market Risk Pool: the market aggregation context used in Table B.4 for consolidated issuer estimates

Table referenceTable B.4 (Appendix B) reports estimated transfer amounts by issuer for the Merged Market Risk Pool across SIM1–SIM4

ExamplesTable B.4 rows include MA issuers (e.g., Tufts, UnitedHealth, HPHC) with SIM1–SIM4 estimates