Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 45
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57Federal tax-exempt issuers:
Part 1, Lines 3.1a + 3.1b + 3.1c + 3.1d + 3.2a + 3.2b + 3.2c + 3.3a + 3.3b, Column
[RC] 3/31
Non Federal tax-exempt issuers:
Part 1, Lines 3.1a + 3.1b + 3.1c + 3.1d + 3.2a + (the higher of 3.2b or 3.2c) + 3.3a
+ 3.3b, Column [RC] 3/31
Note: If Line 3.2b is negative and Line 3.2c is zero or blank (or vice versa), zero
may not be used as the higher of the two: only the negative amount may be
used in the equation.
Note: In all lines where taxes (Line 2.2) are included, an issuer should not consider
risk corridors payments and charges when estimating taxes under the risk
corridors formula.
Line 2.3 – MLR denominator
All Columns – Lines 2.1 – 2.2
For Health Insurance Coverage and Mini-med plans respectively, issuers with experience in both
the individual and small group markets who merge markets in accordance with state law (such as
in Massachusetts, Vermont, and the District of Columbia), should combine Lines 2.1 – 2.2 for both
markets and enter the combined amounts on Line 2.3 in the PY2, PY1, CY, and Total Columns for
both markets (Columns 1-8 for health insurance coverage, Columns 13-20 for Mini-med plans.).
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 may
be combined.
Section 3 – Risk Corridors Calculation
Issuers who did not offer QHPs through the Marketplace during 2015 benefit year should leave Section 3
blank.
Line 3.1 – Allowable Costs
Lines 1.2 + 1.3 – 1.4 – 1.5 – 1.6 + 7.2
Line 3.2 – Administrative Costs Excluding Taxes
Part 1, Lines 5.1 + 5.2 + 5.3 + 5.4 + 5.5a + 5.5b + 5.6, Column [RC] 3/31
Line 3.3 – Profit for Risk Corridors calculation
Enter the greater of Lines 3.3a or 3.3b
3.3a – Earned profit: Lines 2.1 – 3.1– 2.2 – 3.2
3.3b – Capped profit: (3% + 2%) x (Lines 2.1 – 2.2)
44
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