Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 30
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57Exclude:
• Reserves for bad debt or statutory non-admitted amounts
Line 1.8 – Group conversion charges
If the amount entered on Line 1.1 has been reduced or increased by the amount of any conversion
charges associated with group conversion privileges between Group and Individual lines of
business in your annual statement accounting, enter the reverse of these charges on this line in the
appropriate columns.
If an issuer transfers portions of earned premium associated with group conversion privileges
between group and individual lines of business in its Annual Statement, these amounts must be
added to or subtracted from incurred claims. (See Part 2, Section 2 – Claims.)
Line 1.9 – Federal Transitional Reinsurance Program Payments
3/31 Column – Include expected payments from HHS, as shown on the notification received from
HHS by June 30 of the year following the MLR reporting year (unless instructed otherwise
by HHS).
[RC] 3/31 Column – Include:
• Expected payments from HHS for the 2015 benefit year, as shown on the notification
received from HHS by June 30, 2016 (unless instructed otherwise by HHS).
• Subtract from the above the difference between the reinsurance payment amount reported
by the issuer for the 2014 benefit year on the 2014 MLR Form and the reinsurance amount
actually paid to the issuer for the 2014 benefit year. Do not include adjustments for
pending appeals unless the appeal has been resolved (in which case the payment would
have been made).
Line 1.10 – Federal Risk Adjustment Program Net Receipts or Charges
3/31 Column – Include expected net payments from HHS (enter as a positive amount) or charges
payable to HHS (enter as a negative amount), as shown on the notification received from
HHS by June 30 of the year following the MLR reporting year (unless instructed otherwise
by HHS), including any risk adjustment default charges or default charge allocation
amounts.
[RC] 3/31 Column – Include:
• Expected net payments from HHS (enter as a positive amount) or charges payable to HHS
(enter as a negative amount) for the 2015 benefit year, as shown on the notification
received from HHS by June 30, 2016 (unless instructed otherwise by HHS), including any
risk adjustment default charges or default charge allocation amounts.
• Subtract from the above the difference between the risk adjustment amount reported by the
issuer for the 2014 benefit year on the 2014 MLR Form and the amount actually paid to the
issuer for the 2014 benefit year. Do not include adjustments for pending appeals unless the
appeal has been resolved (in which case a payment would have been made).
Line 1.11 – Federal Risk Corridors Program Payments or Charges
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