This guide provides essential troubleshooting tips for resolving issues with community-rated plans. Whether you’re experiencing problems such as rates not loading, plans not populating, or error messages when uploading a census, this resource highlights the most common mistakes brokers encounter when accessing ACA plans and offers practical solutions to address them.
I'm not seeing any Community Rated plans after uploading the census.
Here are the 3 most common reasons why plans may not load.
- Missing or inaccurate Census Data
- Refresh Rates
- Plan Limitations
1. Missing or inaccurate Census Data
The most common issue is unfavorable data on the census. Start by reviewing your census to ensure all information is entered correctly. Plansight requires specific formats for data entry. Refer to the diagram below for details on the required information and correct formats. Cross-check your entries to match the required inputs. For example:
- Use "M" instead of "Male."
- Select "Employee" rather than "EE."
- For multiple plans, assign the corresponding plan number to each individual. Or if there is only one plan, enter "1" for all individuals.
***DO NOT LEAVE ANY OF THE REQUIRED FIELDS BLANK*** All "Required" fields must have data. - If an employee has waived the benefit, remove them from the census.
2. Refresh Rates
We partner with a third-party database called Ideon to source available community-rated plans. Sometimes, resolving issues can be as simple as performing a quick refresh.
To ensure the system pulls the desired information:
- Navigate to the Community Rated Plans screen.
- Click on "REFRESH RATES".
This action will rerun the census and repopulate the plans with the latest data. If the issue persists, double-check the census data for accuracy and required formatting.
3. Plan Limitations
After uploading a census, if no plans or specific carriers are available and a "Plan Limitations" button appears in the top-right corner of the screen, it indicates that certain plans are unavailable to the client. This is typically due to one of the following reasons:
- Low Enrollment Counts. The enrollment numbers do not meet the carrier's minimum required limits.
- Out-of-State Percentage. The percentage of individuals living outside the situs state exceeds the carrier's allowable threshold.
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If this occurs, you may need to reach out to the carrier directly or manually add plans by uploading SBC to the Community Rated library.
I'm not seeing the Community Rated plan as a choice.
When troubleshooting plan availability in Plansight, it's essential to ensure that all settings and data are properly aligned between the system and the carrier's required information. Use the steps below to identify and resolve the 2 most common issues affecting plan availability.
- Verify Employer Address
- Check Plan Availability in Ideon
1. Verify Employer Address
The rating area is determined by employer's address. Ensure the Employer's address in Plansight matches the address the carrier is using to provide the plans. If the address in Plansight differs from the carrier's address, it can affect the plans displayed and available for the assigned rating area.
2. Check Plan Availability in Ideon
Unfortunately, at times plans may not be available to Ideon. You can confirm plan's availability by going directly to Ideon Planwatch https://planwatch.ideonapi.com/ . Confirm all plans have been uploaded into Ideon by filtering results by Year, Quarter, State and Carrier.
If the plan is not showing available, it can be manually uploaded into Plansight using an SBC.
*Once the plan has been created, be sure to obtain rates and input the necessary information.