Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 16

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Any amounts excluded from claims for MLR calculation purposes that are normally included
in claims for financial statement purposes. For example, premium deficiency reserves are
excluded from contract reserves for MLR purposes in Part 2; thus, premium deficiency
reserves would be included on this Line. Include the adjustment for multi-option coverage
amounts (report as a negative amount if offsetting Part 2, Line 2.15).
Line 2.7 – Rebates paid
MLR rebates paid during the MLR reporting year.
Line 2.8 – Estimated rebates unpaid at the end of the previous MLR reporting year
Amount should equal Line 2.9 from the previous MLR reporting form.
Line 2.9 – Estimated rebates unpaid at the end of the MLR reporting year
MLR rebates estimated but unpaid as of the end of the MLR reporting year.
Line 2.10 – Fee-for-service and co-pay revenue (net of expenses)
Include:
Revenue recognized by the issuer for collection of co-payments from members and
revenue derived from health services rendered by reporting entity providers that are
not included in member policies (generally only applicable to staff-model HMOs).
Deduct:
Medical expenses associated with fee-for-service business.
Line 2.11 – Allowable claims recovered through fraud reduction efforts Part 2, Line 2.17.
Section 3 – Federal and State Taxes and Licensing or Regulatory Fees
Any amounts for ACA fees collected in advance of the MLR reporting year in which the fee is payable
may not be reported in Section 3.
Line 3.1 – Federal taxes and assessments incurred by the reporting issuer during the MLR reporting year
3.1a – Federal income taxes deductible from premiums in MLR calculations
Include:
Federal income taxes attributed to the MLR reporting year allocated to the
respective lines of business reported. In Columns [RC] 3/31, income taxes should
exclude the impact of risk corridors payments or receipts on taxable income.
Exclude: Federal income taxes on investment income and capital gains.
3.1b – Patient Centered Outcomes Research Institute (PCORI) Fee
This fee is imposed on an issuer of a specified health insurance policy and a plan sponsor of an
applicable self-insured health plan.
Include:
PCORI fees attributed to applicable policies during the MLR reporting year.
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