Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 49

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exactly matches a deductible level listed in Table 2, the deductible factor associated with that
average deductible level is the factor in Table 2. The deductible factor for a deductible level
between the values shown in Table 2 is determined by linear interpolation (do not round).
Table 2
Health plan deductible Deductible Factor
< $2,500 1.000
$2,500 1.164
$5,000 1.402
>= $10,000 1.736
Enter the amount from the table corresponding with the average deductible. Issuers with non-
credible or fully credible experience do not have a deductible factor and can enter a value of 1.0.
Line 4.5 – Credibility adjustment
Lines 4.2 x 4.4 (DO NOT ROUND)
Issuers with non-credible or fully credible experience do not receive a credibility adjustment and
should enter zero.
Section 5 – Medical Loss Ratio Calculation
Issuers with less than 1,000 aggregated life-years (Line 4.1, Total Column) are presumed to meet the
MLR standard and may leave Section 5 blank.
Line 5.1 – Preliminary Medical Loss Ratio
5.1a – Preliminary MLR
All Columns – Line 1.8 / Line 2.3. Do not round.
5.1b – Preliminary MLR: Mini-Med and Student Health Plans
All Columns – Line 1.9 / Line 2.3. Do not round.
Line 5.2 – Credibility adjustment
Line 4.5, Total Column.
Line 5.3 – MLR including credibility adjustment (if applicable)
Lines 5.1a or 5.1b + 5.2, Total Column. After adding, round to three decimal places, e.g. 0.801 or
80.1%.
Section 6 – MLR Rebate Calculation
Line 6.1 – MLR Standard
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