Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 46
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573.3c – Capped profit without adjustment: (3% x (Lines 2.1 – 2.2))
Line 3.4 – Allowable Administrative Costs
Enter the lesser of Lines 3.4a or 3.4b
3.4a – Profit and administrative costs: Lines 3.2 + 3.3 + 2.2
3.4b – Capped administrative costs: (20% + 2%) x (Lines 2.1 – 2.2) + Line 2.2
Note: As set forth at 45 CFR 153.520, allowable administrative costs must reflect an
amount equal to the pro rata portion of the aggregate amount of such expense across
all of the QHP issuer’s non-grandfathered health plans in a market within a State,
allocated to the QHP based on premiums earned.
Line 3.5 – Risk Corridors Adjusted Target Amount
Lines 2.1 – 3.4
Line 3.6 – Allowable Administrative Costs without (Transitional) Adjustment
Enter the lesser of Lines 3.6b or 3.6c
3.6a – Profit without adjustment (the greater of Lines 3.3a or 3.3c)
3.6b – Profit and administrative costs without adjustment (Lines 3.2 + 3.6a + 2.2)
3.6c – Capped administrative costs without adjustment (20% x (Lines 2.1 – 2.2) + Line 2.2)
Line 3.7 – Risk Corridors Unadjusted Target Amount
Lines 2.1 – 3.6
Line 3.8 – Unadjusted Risk Corridors Ratio
Lines 3.1 / 3.7
Line 3.9 – Risk Corridors Aggregate Amount by Market without Adjustment
Risk Corridors Plan Level Data Form, Tab 3, Line 9
Line 3.10 – Risk Corridors Total Payment or Charge Amount Used for MLR calculation
Risk Corridors Plan Level Data Form, Tab 3, Line 10
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 the amounts for both markets, and use the combined amounts to perform
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