Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 28

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Include:
• Premium assumed under a 100% assumption reinsurance agreement (with a novation) must
be reported by the assuming issuer for the entire MLR reporting year during which the
policies are assumed and must not be reported by the ceding issuer
• Premium assumed under a 100% indemnity reinsurance and administrative agreement,
limited to only those agreements both entered into and also effective prior to March 23,
2010, where the assuming entity is responsible for 100% of the ceding entity’s financial
risk and takes on all of the administration of the block of business
Exclude:
• Premium ceded under a 100% assumption reinsurance agreement (with a novation) must
be reported by the assuming issuer for the entire MLR reporting year during which the
policies are assumed and must not be reported by the ceding issuer
• Premium ceded under a 100% indemnity reinsurance and administrative agreement,
limited to only those agreements both entered into and also effective prior to March 23,
2010, where the assuming entity is responsible for 100% of the ceding entity’s financial
risk and takes on all of the administration of the block of business
• Assessments paid to or subsidies received from State and Federal high risk pools
• Amounts for rate credits paid or received (these amounts must be reported separately on
Part 2, Lines 1.4-1.6 and 2.8-2.10)
Line 1.2 – Unearned premium (year preceding the MLR reporting year)
12/31 Column – report reserves established to account for the portion of the premium paid prior to
the MLR reporting year that was intended to provide coverage during the MLR reporting
year. Report reserves as of 12/31 of the year preceding the MLR reporting year, as
reported to the regulatory authority in the issuer’s State of domicile or as filed on the
NAIC SHCE filing for the year preceding the MLR reporting year.
3/31 Column (premium for coverage in the MLR reporting year only) – report premium for
coverage in the MLR reporting year only, collected in the immediately preceding MLR
reporting year. Report amounts as of 12/31 of the year preceding the MLR reporting year.
PLEASE NOTE: This methodology differs from NAIC SHCE methodology. However, if
the issuer chose to report direct written premium in Line 1.1 on the same basis as in the
12/31 column, the issuer should report unearned premium reserves consistently with how it
reports direct written premium.
Line 1.3 – Unearned premium (MLR reporting year)
12/31 Column – report reserves established to account for the portion of the premium paid in the
MLR reporting year that was intended to provide coverage during the following MLR
reporting year. Report reserves as of 12/31 of the MLR reporting year, as reported to the
regulatory authority in the issuer’s State of domicile or as filed on the NAIC SHCE filing
for the MLR reporting year.
3/31 Column – report zero (note that if collected and due and unpaid premium is reported
correctly in Line 1.1 above, Line 1.1 should not include amounts that would constitute
unearned premium for coverage in years subsequent to the MLR reporting year).
27

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