Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 43
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57Student Health: Lines 1.2 + 1.3
(Note: Use these amounts to determine whether the base credibility factor in Line 4.2 is
allowed. Do NOT use this amount to calculate the 2015 MLR numerator in Line
1.9, Total Column.)
CY Column –
Mini-Med and Student Health: Lines 1.2 + 1.3
Total Column –
Mini-Med and Student Health: Total Column, Lines 1.2 + 1.3
(Note: Mini-Med and Student Health issuers must not apply any multipliers for the 2015
MLR reporting year to any part of the aggregated experience in the Total Column,
except for the transitional policy multiplier described below.)
Expatriate: Not applicable for the 2015 MLR reporting year
For 2014, in States that adopted the CMS transitional policy, if the issuer provided transitional
coverage in the individual and/or small group market(s), the issuer may multiply the sum of
the amounts reported in the PY1 Column Lines 1.2 + 1.3 by 1.0001 before including it in the
calculation for Line 1.9, Total Column, in the relevant State and market.
Issuers with health insurance coverage in both the Mini-Med individual and small group
markets, who merge their markets in accordance with state law (such as in Massachusetts,
Vermont, and the District of Columbia), should combine Lines 1.2 + 1.3 for both markets and
enter the combined amounts (multiplied by the appropriate multiplier) on Line 1.9 in the PY2,
PY1, CY, and Total Columns for both markets (Columns 13-20). Please note that MLR
numerator, denominator, and life-years to determine credibility, and RC calculated fields are
the only fields on the MLR Form where experience for the two markets can be combined.
Section 2 - Medical Loss Ratio Denominator
Line 2.1 – Premium earned including Federal and State high risk programs
PY2 Column – 2013 MLR Form, Part 1, Lines 1.1 + 1.2 + 1.3, Columns 3/31 + Deferred PY1 –
Deferred CY – Part 4 Line 6.1a, Column CY
PY1 Column – 2014 MLR Form, (Part 1, Lines 1.1 + 1.2 + 1.3, Columns 3/31 + Deferred PY1 –
Deferred CY) – (Part 3, Lines 1.5 + 1.6 + 1.7, Column CY) + Part 3 Line 7.1a, Column
PY1
CY Column – (Part 1, Lines 1.1 + 1.2 + 1.3, Columns 3/31 + Deferred PY1 – Deferred CY) –
(Part 3, Lines 1.5 + 1.6 + 1.7, Column CY)
RC Column – (Part 1, Lines 1.1 + 1.2 + 1.3, Column [RC] 3/31) – (Part 3, Lines 1.5 + 1.6,
Column RC)
42
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