Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 48
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57• Line 4.1, PY1 Column is at least 1,000; and
• Line 4.1, CY Column is at least 1,000; and
• Line 5.1a or 5.1b, PY2 Column is less than Line 6.1, PY2 Column; and
• Line 5.1a or 5.1b, PY1 Column is less than Line 6.1, PY1 Column; and
• Line 5.1a or 5.1b, CY Column is less than Line 6.1, CY Column.
Otherwise, if the aggregated life-years as reported in Line 4.1, Total Column exactly matches a
life-year category listed in Table 1 below, the value associated with that number of life-years is the
base credibility factor. The base credibility factor for a number of life-years between the values
shown in Table 1 is determined by linear interpolation. DO NOT ROUND.
Table 1
Life Years Base credibility factor
< 1,000
No Credibility
1,000
8.3%
2,500
5.2%
5,000
3.7%
10,000
2.6%
25,000
1.6%
50,000
1.2%
>= 75,000
0.0% (Full Credibility)
Line 4.3 – Average deductible
Issuers who choose to use a deductible factor of 1.0 can skip Steps 1 and 2, leave Line 4.3 blank,
and enter 1.0 on Line 4.4.
Step 1: Calculate average deductibles separately for policies in force in PY2, PY1, and CY.
The per-person deductible for a policy that covers a subscriber and the subscriber’s
dependents shall be calculated as follows:
The lesser of the deductible applicable to each of the individual family members or
the overall family deductible for the subscriber and subscriber’s family divided by
two (regardless of the total number of individuals covered through the subscriber).
Issuers offering products with differing deductibles should use a weighted average based
upon life-years for each deductible level of policies included in the aggregation.
Step 2: Calculate the weighted average (based upon life-years) of the PY2, PY1, and CY average
deductibles computed in Step 1. Enter this three-year weighted average deductible on Line 4.3.
Line 4.4 – Deductible factor
This amount is calculated based upon the average deductible reported in the Total Column for
Line 4.3. The deductible factor ranges from 1.0 to 1.736 and is shown in Table 2 below and in the
Tables tab of the MLR Form. When the average deductible used to determine the deductible factor
47
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