CCIIO Technical Guidance on Medical Loss Ratio Reporting

Technical Guidance 2012-004 provides guidance in Q s and As on medical loss ratio reporting requirements.

Document Excerpt

 Section 2718 of the Public Health Service Act (PHS Act), as added by the Patient Protection and Affordable Care Act (Affordable Care Act), requires health insurance issuers (issuers) to submit a medical loss ratio (MLR) report to the Secretary and issue a rebate to enrollees if the issuer’s MLR is less than the applicable percentage established in section 2718(b) of the PHS Act. The interim final rule with public comment period implementing MLR requirements was published on December 1, 2010 (75 FR 74864) and modified by technical corrections on December 30, 2010 (75 FR 82277). The final rule implementing MLR requirements (76 FR 76574) and the interim final rule implementing MLR rebate requirements for non-Federal governmental plans (76 FR 76596) were published on December 7, 2011. The MLR regulations are codified at 45 CFR Part 158. A final rule implementing an MLR notice requirement (77 FR 28790) was published on May 16, 2012. This Bulletin provides MLR guidance on the following topic:

• MLR Annual Report Filing Deadline and Rebate Deadline


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