Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (Cms) Page 54
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57Enter the percentage of notices sent by September 30 following the prior MLR reporting year.
Line 4.d – Percentage of notices timely sent to subscribers of group policies owed a rebate
Enter the percentage of notices sent by September 30 following the prior MLR reporting year.
Line 4.e – Percentage of rebate amounts timely paid to individual and group policyholders owed a rebate
Include:
• Rebate amounts paid as a lump-sum check or reimbursement to individual policyholders
and directly to group policyholders (e.g., if this form is being filed for the 2015 MLR
reporting year, include rebates for the 2014 MLR reporting year that were disbursed as a
lump sum by September 30, 2015)
• Rebate amounts credited to individual policyholders and directly to group policyholders
for the premium due on or after September 30, 2015 following the prior MLR reporting
year (e.g., if this form is being filed for the 2015 MLR reporting year, enter the percentage
of rebates based upon the 2014 MLR reporting year that were paid as premium credit
beginning September 30, 2015)
Exclude: Rebates in group markets which the issuer paid directly to the group’s subscribers rather
than to the group policyholder.
Line 4.f – Percentage of rebates amounts timely paid directly to subscribers of group policies owed a
rebate
Enter the percentage of rebate amounts paid by September 30 following the prior MLR reporting
year, for rebates which the issuer paid directly to the group’s subscribers rather than to the group
policyholder.
Line 4.g – Amount of unclaimed rebates from the prior MLR reporting years
Report rebate checks issued but not presented for payment. Report the amount of rebates owed
based on the previous MLR reporting years which remain unpaid because the issuer was unable,
after making a good faith effort, to locate a former policyholder or subscriber, and which have not
yet been escheated or otherwise disbursed.
Line 4.h – Describe the methods used to locate policyholders/subscribers to distribute the prior MLR
reporting years’ unclaimed rebates
Line 4.i – Disbursement method of the prior MLR reporting years’ unclaimed rebates
Describe the method used to disburse the prior MLR reporting years’ unclaimed rebates.
53
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