Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 35
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572.9b – 3/31 Column – refunds associated only with claims incurred during the MLR reporting
year, not paid or received as of 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 2.10 – 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 2.9.
Line 2.11 – Incurred medical incentive pools and bonuses
12/31 Column – based on all payments through 12/31 of the MLR reporting year.
3/31 Column – based on amounts incurred only during the MLR reporting year and paid through
3/31 of the following year.
Include:
Arrangements with providers and other risk sharing arrangements whereby the
reporting entity agrees to either share savings or make incentive payments to providers.
2.11a – Paid medical incentive pools and bonuses for the MLR reporting year.
2.11b – Accrued medical incentive pools and bonuses for the MLR reporting year. Exclude
amounts recorded on Line 2.11a, include only the amount of medical incentive and bonus
pool payments that are estimated to be owed but not yet paid for the MLR reporting year.
2.11c – Accrued medical incentive pools and bonuses for the year preceding the MLR reporting
year.
Line 2.12 – Net healthcare receivables
12/31 Column – receivables reported as of 12/31 of the MLR reporting year.
3/31 Column – receivables incurred during the MLR reporting year and that remain outstanding as
of 3/31 of the following year.
2.12a – Healthcare receivables (MLR reporting year).
2.12b – Healthcare receivables (year preceding the MLR reporting year).
The amounts on these lines are the gross healthcare receivable assets, not just the admitted portion.
These amounts should not include those healthcare receivables, such as loans or advances to non-
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