Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 39
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57pursuant to the regulations at 45 CFR Part 147.140. A plan is not ACA-compliant if it was not
compliant with Affordable Care Act market reforms during the 2014 calendar year. The
Affordable Care Act market reforms are set forth in sections 2701 through 2707 of the Public
Health Service Act (Public Law 78-410), and the implementing regulations in Title 45 of the Code
of Federal Regulations.
Risk corridors amounts in Columns 4A and 8A, Lines 3.1 through 3.10 must be exactly the same
as the corresponding amounts in Tab 3 of the Risk Corridors Plan Level Data Form. Tab 3 of the
Risk Corridors Plan Level Data Form indicates the lines where the data input must be the same as
the data input in Part 3 of the MLR Form. Note that companies that did not offer QHPs through
the Exchange in 2015 do not need to complete the Risk Corridors Plan Level Data Form.
Column Groupings
For the definitions for each of the following markets, see the Column Definitions at the beginning of these
Filing Instructions.
Columns 1–4A
– Individual Market
Columns 5–8A
– Small Group Market
Columns 9–12
– Large Group Market
Columns 13–16
– Mini-Med plans – Individual Market
Columns 17–20
– Mini-Med plans – Small Group Market
Columns 21–24
– Mini-Med plans – Large Group Market
Columns 25–28
– Expatriate plans – Small Group Market (Not applicable for 2015)
Columns 29–32
– Expatriate plans – Large Group Market (Not applicable for 2015)
Columns 33–36
– Student Health plans – Individual Market (GT template only)
LINE INSTRUCTIONS – PART 3
Columns 1–24 are not applicable for the GT template.
Section 1 – Medical Loss Ratio Numerator
Line 1.1 – Adjusted incurred claims as reported on the MLR Form for prior year(s)
PY2 and PY1 Columns – 2013 and 2014 MLR Forms, respectively, Part 1, Lines 2.1 + 2.11,
Columns 3/31 + Deferred PY– Deferred CY
Line 1.2 – Adjusted incurred claims as of 3/31 of the year following the MLR reporting year
Report corrected amounts if prior year’s information was reported inaccurately.
PY2 Column – enter the amount of adjusted incurred claims reported on Part 1, Lines 2.1 + 2.11,
Columns 3/31 + Deferred PY1 – Deferred CY of the MLR Form 2 years prior to the MLR
reporting year, restated as of 3/31 of the year following the MLR reporting year. For
example, for reporting year 2014, enter 2012 adjusted incurred claims restated as of
3/31/2015. (This is also known as claims incurred in 12 months and paid in 39 months.)
Restate all applicable elements of adjusted incurred claims, including reserves and the
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