Section 2718 of the PHS Act and its implementing regulation requires health insurance issuers (issuers) offering group or individual health insurance coverage to submit an annual report to the Secretary of the Department of Health and Human Services concerning the amount the issuer spends each year on claims, quality improvement expenses, non-claims costs, Federal and State taxes, licensing and regulatory fees, the amount of earned premium for the reporting year, its medical loss ratio and any rebate it may owe to subscribers. In addition, the implementing regulation requires issuers to maintain all documents and other evidence which support the data that is provided in an issuer's annual report to the Secretary.
Based upon HHS' experience in the MLR data collection and evaluation process, HHS is updating its annual burden hour estimates to reflect the actual numbers of submissions, rebates and rebate notices. In addition, the notice requirement for issuers that do not owe rebates applied only to the 2011 reporting year, and does not apply to 2012 and subsequent MLR reporting years. The 2012 MLR Reporting Form and instructions also reflect changes for the 2012 reporting year and beyond that are set forth in the December 2011 Final Rule as to whether certain already reported expenditures such as ICD-10 conversion costs are taken into account in calculating an issuer's MLR. In addition, as a result of Tri-Agency guidance, we have revised the MLR Form Instructions to reflect that for the 2012 MLR reporting year, expatriate plans are considered compliant with MLR requirements. For the 2012 MLR reporting year, issuers with only expatriate business are not required to file an MLR Form. Issuers with health insurance coverage which is subject to MLR requirements who also have expatriate experience must report the same limited information regarding their expatriate experience as they do regarding other lines of business that are not subject to the MLR rebate requirements. Therefore, there is a total decrease of 176,378 burden hours (from, 479,928 hours to 303,550).
We have simplified the method by which issuers can enter their data into the reporting form. For the 2012 MLR reporting year, all data cells will be unlocked so that issuers can copy and paste data into the reporting form instead of manually entering data cell by cell. To assist issuers in populating cells that were previously locked and pre-calculated, CMS will provide a reference tool with formula calculations, which issuers may use if they find it helpful. The new method will reduce the burden on issuers as well as the possibility of error in formula results.
The 2012 MLR Reporting Form and instructions also reflect changes for the 2012 reporting year and beyond that are set forth in the December 2011 Final Rule as to whether certain already reported expenditures such as ICD-10 conversion costs are taken into account in calculating an issuer's MLR. In addition, as a result of Tri-Agency guidance, we have revised the MLR Form Instructions to reflect that for the 2012 MLR reporting year, expatriate plans are considered compliant with MLR requirements.
For the 2012 MLR reporting year, issuers with only expatriate business are not required to file an MLR Form. Issuers with health insurance coverage which is subject to MLR requirements who also have expatriate experience must report the same limited information regarding their expatriate experience as they do regarding other lines of business that are not subject to the MLR rebate requirements.
$72,288
No
No
Yes
No
No
Uncollected
William Parham 4107864669
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-10418 Notice of Rebate to Enrollees
CMS 10418 2012 MLR PRA Package 60day FR Q and As.pdf
CMS 10418 2012 MLR 30Day FR Notice Crosswalk of Changes.docx
Retention of Records