Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 11
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57Include:
Experience from policies for the relevant market newly issued in the 2014 MLR
reporting year (PY1), previously deferred, as provided in the General Instructions.
Data elements constituting adjusted incurred claims for business deferred from the
preceding MLR reporting year should be restated as of 3/31 of the year following
the MLR reporting year.
Columns 5, 10, 15, 39 – Deferred Newer Business for the MLR reporting year
Include:
Policies for the relevant market newly issued in the 2015 MLR reporting year, as
defined more specifically in the General Instructions, deferred for reporting
purposes at the issuer’s option.
Columns 1–5
Individual Market
Include:
Health insurance where the policy is issued to an individual covering the individual
and his or her dependents in the individual market.
Columns 6–10
Small Group Market
Include:
All policies issued in the small group market (including fully insured State and
local government policies).
Columns 11–15
Large Group Market
Include:
All policies issued in the large group market (including the Federal Employees
Health Benefit Program and fully insured State and local government policies).
Columns 16–24
Mini-Med Plans
Include:
All policies that have a total annual limit of $250,000 or less for individual, small
group, and large group markets, in their respective columns.
Columns 25–34
Expatriate Plans (GT Template only. 12/31 column only)
Include:
All group policies written in the United States that provide coverage for employees
working outside their country of citizenship; working outside of their country of
citizenship and outside the employer’s country of domicile; or non-U.S. citizens
working in their home country. These policies are to be reported on a nationwide,
aggregated basis, separately for the small group and the large group markets, as of
12/31 on the GT template only.
Columns 35–39
Student Health Plans (GT template only)
Include:
All health insurance policies issued to students and their dependents pursuant to a
written agreement between the issuer and the institution of higher education, as
defined by 45 CFR §147.145.
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