Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 34
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57Line 2.6 – Direct contract reserve (MLR reporting year)
Report the amount of reserves required when, due to the gross premium structure, the future
benefits exceed the future net premium. Contract reserves are in addition to claim liabilities and
claim reserves.
Include:
Contract reserves and other claims related reserves.
Exclude: Premium deficiency reserves.
Reserves for expected MLR rebates.
2.6a – 12/31 Column – 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 reported on the NAIC SHCE
filing for the MLR reporting year.
2.6b – 3/31 Column – for policies issued prior to 2011, contract reserves may only be used in the
MLR calculation if such reserves were held prior to 2011, and may include reserves used
for the purpose of leveling policy duration-based variation in claims experience only if
durational contract reserves were held for such policies prior to 2011. Reported contract
reserves may not exceed contract reserves calculated using the applicable product pricing
assumptions. Calculate as of 12/31 of the MLR reporting year.
Line 2.7 – Direct contract reserves prior year (year preceding the MLR reporting year)
12/31 Column – amount reported as of 12/31 of the year preceding the MLR reporting year.
3/31 Column – amount reported on Line 2.6b in the 3/31 Column of the MLR Form for the
preceding year.
Line 2.8 – Experience rating refunds (rate credits) paid or received
2.8a – 12/31 Column – report all refunds paid or received through 12/31 of the MLR reporting
year.
2.8b – 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 2.9 – Reserves for experience rating refunds (MLR reporting year)
2.9a – 12/31 Column – all refunds unpaid as of 12/31 of the MLR reporting year.
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