Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 3

ADVERTISEMENT

or health maintenance organization contract offered by a health insurance issuer. The definition includes
any insurance product, such as drug, chiropractic, or mental health coverage, whether sold as a stand-
alone product or in conjunction with any other health insurance coverage, unless specifically identified as
“excepted benefits” by the PHSA.
An MLR Form must be prepared and submitted for each State in which the issuer has written direct health
insurance coverage or has direct amounts paid, incurred, or unpaid for the provision of health care
services. In addition, the issuer must submit a Grand Total (GT) template containing the grand total of its
business in all States. (Note: The experience of expatriate and student health plans is aggregated on a
national basis and should be reported only on the GT template.) Parts 1 and 2, both the 12/31 and
3/31 columns, must be completed for each State in which the issuer provides any health insurance
coverage subject to MLR requirements, even if a particular State will show $0 earned premium in Part 1.
Except for the GT template, Parts 3 through 5 must be completed for any State in which there are non-
zero amounts in Part 1. Part 3 through 5 of the GT template should only be completed for Student Health
Plans. Part 6 should be completed in the GT template only. However, while an issuer is not required to
submit State templates for those States where the issuer has no business subject to MLR, the GT template
should include the issuer’s entire nationwide business for Columns 40-43. Note that this may cause
Columns 40-43 on the GT template to show higher amounts than the sum of the corresponding amounts
on the State templates.
2

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical