Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 5
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57General Instructions
Company Information Tab
The information in the Company Information tab of the MLR Form is pre-populated. If any of the
information needs to be changed, please refer to the Company/Issuer Associations tab in HIOS (see
section 3.1.1 of the HIOS User Manual).
Recommended Order for Completing the MLR Form
Part 1
Part 3
Part 2
Parts 4-6
Summary of
MLR and
Premium
Rebate Disbursement
Data
Rebate
and Claims
Additional Responses
Calculation
Expense Allocation
The information populated into Part 2 of the MLR Form is used to populate certain cells in Part 1, and
information in Parts 1 and 2 is used for certain calculations in Parts 3 and 4. Therefore, it is suggested that
Part 2 be completed first, followed by Part 1, Part 3, and then Parts 4-6. (Note: Part 6 is only completed in
the GT template.)
-
Issuers subject to risk corridors reporting should complete the RC columns on Part 3 through Line
3.8; use the results to complete the Risk Corridors (RC) Plan-Level Data Form; copy the required
fields from the RC Plan-Level Data Form into both Parts 2 and 3 of the MLR Form; and only then
complete the remaining Part 3 fields in the MLR columns of the MLR Form.
General Submission Process
Submission of the MLR and RC templates should be completed in the following order:
1)
Upload the zip file that includes all required MLR templates.
2)
Wait for the automated email from HIOS confirming that the MLR upload was successful.
3)
Upload the zip file that includes all required RC template(s) (if applicable).
4)
Complete attestation only after you successfully upload both MLR and, if applicable, RC
templates.
General Requirements for Reporting Certain Types of Business
Reinsurance
Experience under a 100% assumption reinsurance agreement (with a novation) must be reported
by the assuming issuer as direct business, for the entire MLR reporting year during which the
policies are assumed and must not be reported by the ceding issuer.
Reporting of 100% indemnity reinsurance and administrative agreements is limited to those
agreements both entered into and effective prior to March 23, 2010, where the assuming entity is
responsible for 100% of the ceding entity’s financial risk and takes on all of the administration of
the block of business. Experience under those indemnity reinsurance and administrative
agreements must be reported by the assuming issuer as direct business, and must not be reported
by the ceding issuer.
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