Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 40
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57allowable claims recovered through fraud reduction efforts, in accordance with the Filing
Instructions from 2 years prior to the MLR reporting year.
PY1 Column – enter the amount of adjusted incurred claims reported on Part 1, Line 2.1 + 2.11,
Columns 3/31 + Deferred PY1 – Deferred CY of the MLR Form for the preceding MLR
reporting year, restated as of 3/31 of the year following the MLR reporting year. (This is
also known as claims incurred in 12 months and paid in 27 months). Restate all applicable
elements of adjusted incurred claims, including reserves and the allowable claims
recovered through fraud reduction efforts, in accordance with the Filing Instructions from
the year preceding the MLR reporting year.
CY Column – Part 1, Lines 2.1 + 2.11, Columns 3/31 + Deferred PY1 – Deferred CY (Note that
adjusted incurred claims in the Deferred PY1 columns on Parts 1 and 2 should have been
restated as of 3/31 of the year following the MLR reporting year.)
RC Column – Part 1, Lines 2.1 + 2.11, Column [RC] 3/31
Line 1.3 – Improving Health Care Quality Expenses
PY2 and PY1 Columns – 2013 and 2014 MLR Forms, respectively, Part 1, Lines 4.1 + 4.2 + 4.3 +
4.4 + 4.5 + 4.6, Columns 3/31 + Deferred PY1 – Deferred CY
CY Column – Part 1, Lines 4.1 + 4.2 + 4.3 + 4.4 + 4.5 + 4.6, Columns 3/31 + Deferred PY1 –
Deferred CY
RC Column – Part 1, Lines 4.1 + 4.2 + 4.3 + 4.4 + 4.5 + 4.6, Column [RC] 3/31
Line 1.4 – Reconciled Payments of Cost-Sharing Reductions
PY1 Column – Amount of cost-sharing reductions for 2014, as reconciled in 2016.
CY Column – Part 2, Line 2.18, Columns 3/31 + Deferred PY1 – Deferred CY
RC Column – Part 2, Line 2.18, Column [RC] 3/31. Report a reconciled CSR amount that
reflects: the reconciled CSR amount for the 2015 benefit year (as reported to the issuer by CMS),
minus the difference between the CSR amount reported by the issuer on the 2014 MLR Form and
the reconciled CSR amount for the 2014 benefit year (as reported to the issuer by CMS).
Line 1.5 – Federal Transitional Reinsurance Program payments
PY1 Column – 2014 MLR Form, Part 2, Line 1.9, Columns 3/31 + Deferred PY1 – Deferred CY.
Restate amounts to reflect any changes or updates to reinsurance payments for the 2014
benefit year communicated by HHS after June 30, 2015, including any changes
communicated after the filing of the 2014 MLR Form.
CY Column – Part 2, Line 1.9, Columns 3/31 + Deferred PY1 – Deferred CY
RC Column – Part 2, Line 1.9, Column [RC] 3/31. The issuer can adjust for differences in
reinsurance payments that were actually received after June 30, 2015 that differ from the
39
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