Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 10
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57Columns 2, 2A, 7, 7A, 12, 17, 20, 23, 36 – Business as of 3/31 of subsequent MLR reporting year
Financial information reported in the 3/31 columns should equal the amount of each element
related specifically to experience in the 2015 MLR reporting year and paid through March 31 of
the subsequent reporting year (incurred in 12, paid or received in 15), plus any provision for items
properly allocable to the 2015 MLR reporting year but not yet paid as of 3/31 of the following
year, except as otherwise noted in line instructions. For example, these columns could include
differences from the 12/31 columns in the upper limit for a small group and the lower limit for a
large group, if state group size regulations differ from federal group size regulations. (See the
Definitions of Small Group and Large Group, in the General Instructions above.) These columns
could also include differences from the 12/31 columns in the accounting for the Federal
reinsurance, risk corridors, and risk adjustment amounts. If the issuer elects to treat the out-of-
network experience of an affiliate that provides the out-of-network coverage as if it were related to
the contract providing the in-network coverage, the issuer must include such out-of-network
experience in the 3/31 columns, as well as separately report it in the Dual Contract columns (see
the column definition below).
Include:
Experience of policies in each market, incurred, paid or received relevant only to
the MLR reporting year, reported as of March 31 of the subsequent MLR reporting
year.
Columns 2A and 7A only – Individual and Small Group Health Insurance [Risk Corridors]
Companies that did not offer QHPs through the Exchange in 2015 do not need to complete the risk
corridors columns 2A and 7A. Note that columns 2A and 7A are a subset of columns 2 and 7.
Exclude:
Grandfathered plans and non-grandfathered plans that are not ACA-compliant.
Grandfathered plans are plans that were in effect on March 23, 2010, and that have
not been changed in ways that substantially reduce benefits or increase cost-sharing
for consumers, pursuant to the regulations at 45 CFR Part 147.140. A plan is not
ACA-compliant if it was not compliant with Affordable Care Act market reforms
during the 2015 calendar year. The Affordable Care Act market reforms are set
forth in sections 2701 through 2707 of the Public Health Service Act (Public Law
78-410), and the implementing regulations in Title 45 of the Code of Federal
Regulations.
Columns 3, 8, 13, 18, 21, 24, 37 – Dual Contract
If an issuer chooses to treat the out-of-network experience of an affiliate that provides the out-of-
network coverage as if it were related to the contract providing the in-network coverage, the issuer
must report the out-of-network experience in the 3/31 columns, as well as the Dual Contract
column.
Include:
Experience reported in columns 2, 7, 12, 17, 20, 23, and 36 that is attributable to
dual contracts. Note that these amounts are a subset of what is reported as of 3/31.
Columns 4, 9, 14, 38 – Deferred Newer Business from prior MLR reporting year
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