Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 38
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57Instructions for MLR Annual Reporting Form − Part 3
(MLR and Rebate Calculation)
These MLR Form Filing Instructions only apply to the 2015 MLR reporting year and its reporting
requirements. These Filing Instructions will be revised to reflect changes that apply to the filing years
subsequent to 2015.
No data should be entered in any of the cells shaded grey.
COLUMN DEFINITIONS – PART 3
Columns 1, 5, 9, 13, 17, 21 – PY2
Report the information for the MLR reporting year that is 2 years prior to the MLR reporting year.
Report corrected amounts if reported in error in prior MLR Form submissions. All elements
should be reported in accordance with the applicable reporting year’s instructions. Exception: Line
1.1 should be reported as originally submitted.
Columns 2, 6, 10, 14, 18, 22 – PY1
Report the information for the MLR reporting year that is 1 year prior to the MLR reporting year.
Report corrected amounts if reported in error in prior MLR Form submissions. All elements
should be reported in accordance with the applicable reporting year’s instructions. Exception: Line
1.1 should be reported as originally submitted.
Columns 3, 7, 11, 15, 19, 23, 35 – CY
Report the information for the MLR reporting year.
Columns 4, 8, 12, 16, 20, 24, 36 – Total
For Sections 1 and 2 and Line 4.1, report the sum of the amounts in PY2, PY1, and CY columns,
except for Lines 1.8, 1.9, and 2.3. Otherwise, follow line instructions. The Total column is used to
calculate the numerator and denominator of the MLR calculation. CY adjusted premium is used to
calculate the issuer’s rebate, if any.
Columns 4A, 8A – RC
For Section 3, report information for the risk corridors calculation for the applicable benefit year
(MLR reporting year). Follow line instructions for Lines 3.1 through 3.10. Information reported
in column 4A should be for individual market business only. Information reported in column 8A
should be for small group market business only.
Companies that did not offer QHPs through the Exchange in 2015 do not need to complete the risk
corridors columns 4A and 8A.
Exclude: Grandfathered plans and non-grandfathered plans that are not ACA-compliant.
Grandfathered plans are plans that were in effect on March 23, 2010, and that have not been
changed in ways that substantially reduce benefits or increase cost-sharing for consumers,
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