Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms)
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57Centers for Medicare & Medicaid Services (CMS)
Medical Loss Ratio (MLR) Annual Reporting Form
Filing Instructions for the 2015 MLR Reporting Year
Table of Contents
Instructions for the 2015 MLR Reporting Year ......................................................................................... 1
Changes to the 2015 MLR Annual Reporting Form .................................................................................. 3
General Instructions ................................................................................................................................... 4
Column Definitions for MLR Annual Reporting Form − Parts 1 and 2 .................................................... 8
Instructions for MLR Annual Reporting Form − Part 1 ........................................................................... 13
(Summary of Data) ................................................................................................................................... 13
Instructions for MLR Annual Reporting Form − Part 2 ........................................................................... 26
(Premium and Claims) .............................................................................................................................. 26
Instructions for MLR Annual Reporting Form − Part 3 ........................................................................... 37
(MLR and Rebate Calculation) ................................................................................................................ 37
Instructions for MLR Annual Reporting Form – Part 4 ........................................................................... 51
(Rebate Disbursement) ............................................................................................................................. 51
Instructions for MLR Annual Reporting Form – Part 5 ........................................................................... 54
(Additional Responses) ............................................................................................................................ 54
Instructions for MLR Annual Reporting Form − Part 6 ........................................................................... 55
(Expense Allocation Methodology) ......................................................................................................... 55
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1164. The time
required to complete this information collection is estimated to average 64 hours or 3,840 minutes per response, including the
time to review instructions, search existing data resources, gather the data needed and complete and review the information
collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please
write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850.
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