Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 53
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57Exclude: Rebates being paid in the individual market and rebates in group markets which the
issuer is paying directly to the group’s subscribers rather than to the group
policyholder.
Line 2.b – Number of subscribers being paid a rebate
• Individual market: All subscribers under individual policies that are due a rebate. This does
not include dependents; consequently, this is not the number of covered lives or life-years.
• Small and large group markets: Those subscribers to whom the issuer is paying the rebate
directly. This does not include subscribers where the issuer is paying the rebate to the group
policyholder. This is not the number of employers, covered lives or life-years; typically, this
is the number of employees (not including dependents).
Line 2.c – Number of group policyholders whose calculated rebate is de minimis
De Minimis –
• For a group policy for which the issuer distributes the rebate directly to the policyholder, if
the total rebate owed to the policyholder and its subscribers combined is less than $20 for
the MLR reporting year. This is not the number of certificates, covered lives or life-years;
typically, this is the number of employers.
Line 2.d – Number of subscribers whose calculated rebate is de minimis
De Minimis –
• For a group policy for which the issuer distributes the rebate directly to the subscribers, if
the total rebate owed to each subscriber is less than $5 for a given MLR reporting year.
This is not the number of employers, covered lives or life-years; typically, this is the
number of employees (not including dependents).
• For an individual policy, if the total rebate owed to each subscriber is less than $5 for a
given MLR reporting year. This does not include dependents; consequently, this is not the
number of covered lives or life-years.
Section 3 – Total amount of rebates
Line 3.a – Total amount of rebates (from Part 3, Line 6.4)
Line 3.b – Total amount of de minimis rebates
Line 3.c – Amount of rebates being paid by premium credit
Line 3.d – Amount of rebates being paid by lump-sum reimbursement
Section 4 – Prior MLR year rebates
Line 4.a – Total amount of rebates paid for the previous MLR reporting year
Line 4.b – Total amount of rebates still owed for the previous MLR reporting year
Line 4.c – Percentage of rebate notices timely sent to individual and group policyholders owed a rebate
52
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