Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 50

ADVERTISEMENT

PY2 Column – 2013 MLR Form, Part 4, Line 5.1, Total Column
PY1 Column – 2014 MLR Form, Part 3, Line 6.1, Total Column
CY and Total Columns – The applicable MLR standard is based on one of the following:
• The statutory MLR standard for the relevant market (i.e., 80% for the individual market
and small group market; and 85% for the large group market); or
• The HHS-approved adjusted MLR standard for a particular State’s individual market; or
• The State MLR standard, if the State requires a higher percentage than the statutory MLR
standard for the relevant market for rebate purposes.
• If an issuer thinks a State’s higher MLR standard does not apply to its MLR and rebate
requirements under Federal law, please contact CCIIO at MLRQuestions@cms.hhs.gov.
Line 6.2 – Credibility-adjusted MLR
Line 5.3, Total Column
Line 6.3 – Adjusted earned premium
Lines 2.1 – 2.2, CY Column only
Line 6.4 – Rebate amount if credibility-adjusted MLR is less than the MLR standard
(Lines 6.1 – 6.2) x Line 6.3, Total Column
If Line 6.3 is negative, enter zero ($0) in Line 6.4.
Section 7 – Temporary Adjustments
Line 7.1 - ACA assessments on non-calendar year policies (Column PY2 only)
For the 2013 MLR reporting year, issuers were allowed to defer including in their MLR and rebate
calculations the portion of 2013 premiums collected for 2014 ACA assessments or fees on non-calendar
year policies, and the associated federal and state taxes and fees. If issuers elected to defer these amounts
in the 2013 MLR and rebate calculations, they must disclose and add back these amounts in the 2014 and
2015 MLR and rebate calculations.
7.1a Disclose the deferred portion of premium for each respective State and market. If this amount
was excluded from Line 2.1, Column CY of the 2013 MLR Form, subtract it from Line 2.1,
Column PY2 (so that Line 2.1, Column PY2 of the 2015 MLR Form equals the amount
reported in Line 2.1, Column CY of the 2013 MLR Form), and add it to Line 2.1, Column
PY1 (so that Line 2.1, Column PY1 of the 2015 MLR Form equals the amount reported in
Line 2.1, Column CY of the 2014 MLR Form).
7.1b Disclose the total Federal and State taxes paid on the associated premium revenue. If this
amount was excluded from Line 2.2, Column CY of the 2013 MLR Form, subtract it from
Line 2.2, Column PY2 (so that Line 2.2, Column PY2 of the 2015 MLR Form equals the
amount reported in Line 2.2, Column CY of the 2013 MLR Form), and add it to Line 2.2,
49

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical