Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 52
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57Instructions for MLR Annual Reporting Form – Part 4
(Rebate Disbursement)
These MLR Form Filing Instructions only apply to the 2015 MLR reporting year and its reporting
requirements. These Filing Instructions will be revised to reflect changes that apply to the filing years
subsequent to 2015.
The Column Definitions, which immediately follow the General Instructions at the beginning of these
Filing Instructions, apply to the markets to be reported in Columns 1 through 9 of Part 4.
Column 1
– Individual Market
Column 2
– Small Group Market
Column 3
– Large Group Market
Column 4
– Mini-Med plans – Individual Market
Column 5
– Mini-Med plans – Small Group Market
Column 6
– Mini-Med plans – Large Group Market
Column 7
– Expatriate plans – Small Group Market (not applicable in 2014)
Column 8
– Expatriate plans – Large Group Market (not applicable in 2014)
Column 9
– Student Health plans – Individual Market
Additional definitions:
• Group Policyholder means any entity that has entered into a contract with an issuer to receive health
insurance coverage. (Applicable only in the group markets.)
• Subscriber (Applicable in all markets.)
o In the individual market, subscriber means the person who purchases an individual policy and
who is responsible for the payment of premiums. This does not include the number of
dependents and therefore does not correspond to the number of covered lives or life-years;
rather, this corresponds to the number of individual policies.
o In the group market, subscriber means the person, generally the employee, whose eligibility is
the basis for the enrollment in the group health plan and who is responsible for the payment of
premiums. This does not correspond to the number of group policyholders (e.g. employers).
This also does not include the number of dependents and therefore does not correspond to the
number of covered lives or life-years; rather, this corresponds to the number of certificates
(e.g. number of employees).
Section/Line 1 – Number of policies/certificates (from Part 1, Line 7.1)
Section 2 – Number of policyholders/subscribers owed rebates
Line 2.a – Number of group policyholders who are being paid a rebate (only applicable in the group
markets)
Include:
All group policies (e.g. employers) within the respective group markets that are due a
rebate and to whom the issuer is paying the rebate directly. This is a count of the
groups, not a count of the certificates, covered lives, or life-years in the groups.
51
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