Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 18
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
573.2c – Community benefit expenditures deductible from premium in MLR calculations
Federal tax exempt issuers: May report a value for 3.2b and 3.2c. DO NOT enter community
benefit expenditures in excess of the allowable capped amount. Community benefit
expenditures are limited to the highest of either:
1. Three percent of earned premium; or
2. The highest health insurance coverage premium tax rate in the State for which the
report is being submitted, multiplied by the issuer's earned premium in the applicable
State market.
Non-Federal tax exempt issuers: May report a value for 3.2b or 3.2c, but not both. Issuers may
not report zero ($0) community benefit expenditures in lieu of negative State premium taxes.
DO NOT enter community benefit expenditures in excess of the allowable capped amount.
Community benefit expenditures are limited to:
• The highest health insurance coverage premium tax rate in the State for which the
report is being submitted, multiplied by the issuer’s earned premium in the applicable
State market.
If an issuer uses the highest premium tax rate in the State, the issuer must report the applicable
highest State health premium tax rate in Part 6, Line 1.
Note: Issuers must indicate their Federal tax exempt status in the Company Information tab.
**Community benefit expenditures are for activities or programs that seek to achieve the
objectives of improving access to health services, enhancing public health, and relief of
government burden. This includes activities that:
• Are available broadly to the public and serve low-income consumers;
• Reduce geographic, financial or cultural barriers to accessing health services, and if
ceased to exist would result in access problems (e.g., longer wait times or increased
travel distances);
• Address Federal, State or local public health priorities, such as advancing health care
knowledge through education or research that benefits the public;
• Leverage or enhance public health department activities, such as childhood
immunization efforts; or
• Otherwise would become the responsibility of government or another tax-exempt
organization.
Line 3.3 – Regulatory authority licenses and fees
3.3a – Federal Transitional Reinsurance Program Contributions
Include:
Federal reinsurance contributions required under Section 1341 of the Affordable
Care Act owed for the MLR reporting year. Report the entire contribution amount,
including contribution amounts allocable to the reinsurance payment pool and
program administrative expense, and to the General Fund of the U.S. Treasury.
3.3b – Other Federal and State regulatory authority licenses and fees incurred by the reporting issuer
during the MLR reporting year
Include:
17
ADVERTISEMENT
0 votes
Related Articles
Related forms
Centers For Medicare & Medicaid Services (cms) Inpatient Prospective Payment System (ipps) Quality Reporting Programs
Medical
Form Cms-r-0235a - Data Use Agreement (dua) Addendum For Data Acquired From The Centers For Medicare & Medicaid Services (cms) 2012
Legal
Form Cms-10252 - Data Use Agreement (dua) Certificate Of Disposition (cod) For Data Acquired From The Centers For Medicare & Medicaid Services (cms)
Medical
Form Cms-r-0235 - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data Containing Individual Identifiers
Medical
Form Cms-r-0235u - Data Use Agreement (dua)- Update To Existing Dua - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data
Medical
Related Categories
Parent category: Medical