Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 14
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57Instructions for MLR Annual Reporting Form − Part 1
(Summary of Data)
These MLR Form Filing Instructions only apply to the 2015 MLR reporting year and its reporting
requirements. These Filing Instructions will be revised to reflect changes that apply to the filing years
subsequent to 2015.
In addition to the instructions below, the General Instructions and Column Definitions at the beginning of
these Filing Instructions apply to Part 1. The General Instructions and Column Definitions include
instructions regarding reporting of reinsurance, deferred business, individual business through an
association, employer business through a group trust or MEWA, group coverage in multiple States, and
dual contract group health coverage.
Please note that the MLR Form and Filing Instructions implement the requirements of 45 CFR Parts 153
and 158 and are not identical to the definitions or instructions of the NAIC’s SHCE.
Section 1 – Premium
Line 1.1 – Total direct premium earned
Part 2, Lines 1.1 + 1.2 – 1.3 – 1.7 + 1.8 + 1.9 + 1.10 + 1.11
Line 1.2 – Federal high risk pools
Enter subsidies received or (assessments paid) under Federal high risk pools.
Line 1.3 – State high risk pools
Enter subsidies received or (assessments paid) under State high risk pools.
Exclude: Amounts included in Line 2.4.
Line 1.4 – Net assumed less ceded reinsurance premiums earned
The amount to net against the assumed reinsurance premiums earned is: the ceded reinsurance
premiums written; plus the change in unearned premium reserve that is transferred to the
company assuming the risk; plus the change in reserve credit taken other than for unearned
premiums.
Line 1.5 – Other adjustments due to MLR calculations – premiums
Include:
Any amounts excluded from premium for MLR calculation purposes that are
normally included in premiums for financial statement purposes.
Amounts for rate credits paid and the change in reserve for rate credits that were excluded
from Line 1.1 Total Direct Premiums Earned.
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