Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 17
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573.1c – Affordable Care Act section 9010 Fee
This fee is imposed on an issuer of fully insured health plans with at least $25 million in net
premiums in proportion to the issuer’s market share.
Include:
ACA section 9010 fees payable during the MLR reporting year.
Exclude: ACA section 9010 fees payable in the preceding or following reporting years,
regardless of whether such fees were incorporated in or billed with premium for the
MLR reporting year.
3.1d – Other Federal Taxes (other than income tax) and assessments deductible from premium
Include:
Federal taxes and assessments (other than income taxes) allocated to the respective
lines of business.
Exclude: Fines, penalties, and fees for examinations by any Federal departments.
Line 3.2 – State insurance, premium, and other taxes incurred by the reporting issuer during the MLR
reporting year (deductible from premium in MLR calculation)
3.2a – State income, excise, business, and other taxes, allocated to the respective lines of business
reported, that may be excluded from earned premium under 45 CFR §158.162(b)(1)
Include:
• Any industry wide (or subset) assessments (other than surcharges on specific claims)
paid to the State directly, or premium subsidies that are designed to cover the costs of
providing indigent care or other access to health care throughout the State, or market
stabilization redistributions, or cost transfers for the purpose of rate subsidies, not
directly tied to claims, and that are authorized by State law
• Guaranty fund assessments. Note: if such assessments will be offset in future years
through reductions in state taxes or through premium surcharges, as permitted by the
state, the issuer may defer reporting such guaranty fund assessments until the year(s) of
offset.
• Assessments of State industrial boards or other boards for operating expenses or for
benefits to sick employed persons in connection with disability benefit laws or similar
taxes levied by States
• Advertising required by law, regulation or ruling, except advertising associated with
investments
• State income, excise, and business taxes other than premium taxes
Exclude: Fines, penalties, and fees for examinations by any State departments.
3.2b – State premium taxes
Include:
State premium taxes or State taxes based on policy reserves if in lieu of premium
taxes related to the respective lines of business.
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