Instructions for MLR Annual Reporting Form − Part 1 (Summary of Data) 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. In addition to the instructions below, the General Instructions and Column Definitions at the beginning of these Filing Instructions apply to Part 1. The General Instructions and Column Definitions include instructions regarding reporting of, individual business through an association, and an employer business through a group trust or MEWA. Please note that the MLR Form and Filing Instructions implement the requirements of Health and Safety Code section 1367.004 and Insurance Code section 10112.26 and are not identical to the definitions or instructions of the DMHC reporting form. Section 1 Premium: – Line 1.1 Total direct premium earned – Part 2, Lines 1.1 + 1.2 1.3 1.4 – – Section 2 Claims: – Line 2.1 Total incurred claims – Part 2, Line 2.11 Section 3 Federal and State Taxes and Licensing or Regulatory Fees: – Line 3.1 Federal taxes and assessments incurred by the reporting health plan or health insurer during – the MLR reporting year Federal income taxes deductible from premiums in MLR calculations – Include: Federal income taxes attributed to the MLR reporting year allocated to the respective lines of business reported. Exclude: Federal income taxes on investment income and capital gains. Other Federal Taxes (other than income tax) and assessments deductible from premium – Include: Federal taxes and assessments (other than income taxes) allocated to the respective lines of business.
Instructions for MLR Annual Reporting Form − Part 1 (Summary of Data) 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. In addition to the instructions below, the General Instructions and Column Definitions at the beginning of these Filing Instructions apply to Part 1. The General Instructions and Column Definitions include instructions regarding reporting of, individual business through an association, and an employer business through a group trust or MEWA. Please note that the MLR Form and Filing Instructions implement the requirements of Health and Safety Code section 1367.004 and Insurance Code section 10112.26 and are not identical to the definitions or instructions of the DMHC reporting form. Section 1 – Premium: Line 1.1 – Total direct premium earned Part 2, Lines 1.1 + 1.2 – 1.3 – 1.4 Section 2 – Claims: Line 2.1 – Total incurred claims Part 2, Line 2.11 Section 3 – Federal and State Taxes and Licensing or Regulatory Fees: Line 3.1 – Federal taxes and assessments incurred by the reporting health plan or health insurer during the MLR reporting year – Federal income taxes deductible from premiums in MLR calculations Include: Federal income taxes attributed to the MLR reporting year allocated to the respective lines of business reported. Exclude: Federal income taxes on investment income and capital gains. – Other Federal Taxes (other than income tax) and assessments deductible from premium Include: Federal taxes and assessments (other than income taxes) allocated to the respective lines of business.
AB1962_Instruction-Yr-2015_DMHC-Final.docx