Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 29
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57PLEASE NOTE: This methodology differs from the 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. Do not include any amounts collected during 2015 for
2016 ACA fees as unearned premium.
Line 1.4 – Experience rating refunds (rate credits) paid or received
1.4a – 12/31 Column – report all refunds paid or received through 12/31 of the MLR reporting
year.
1.4b – 3/31 Column – report refunds associated only with claims incurred during the MLR
reporting year, paid or received through 3/31 of the following year.
Include:
Experience rating refunds and State premium refunds paid or received during the MLR
reporting year. Experience rating refund is the return of a portion of premium pursuant
to a retrospectively rated funding arrangement when the sum of incurred losses,
retention, and margin are less than earned premium.
Exclude: Federal and State MLR rebates, and risk corridors payments or charges.
Line 1.5 – Reserves for experience rating refunds (MLR reporting year)
12/31 Column – all refunds unpaid as of 12/31 of the MLR reporting year.
3/31 Column –refunds associated only with claims incurred during the MLR reporting year, not
paid or received through 3/31 of the following year.
Include:
Reserves for experience rating refunds, plus reserves for State premium refunds.
Exclude: Reserves for Federal and State MLR rebates, premium stabilization reserves, and risk
corridors reserves or accruals.
Deduct:
Amounts receivable under retrospectively rated funding arrangements.
Line 1.6 – Reserves for experience rating refunds (year preceding the MLR reporting year)
12/31 Column – as of 12/31 of the year preceding the MLR reporting year.
See instructions for Line 1.5.
Line 1.7 – Premium write-offs
Include:
• Agents’ or premium balances determined to be uncollectible and written off as losses
• Recoveries made during the MLR reporting year on balances previously written off
• Include actual write-offs
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