02-031 C.M.R. ch. 940, § 14 - Rebates and Medical Loss Ratio Reporting

Current through 2022-14, April 6, 2022

A. All reporting forms relating to MLR and rebates under the ACA that are required to be filed with the U.S. Department of Health and Human Services must be submitted to the Superintendent on or before the earlier of the date the forms are filed with the U.S. Department of Health and Human Services or the date they are required to be filed under the ACA, as modified by any extension of time granted by the U.S. Department of Health and Human Services or by the Superintendent.

B. Except as provided in Subsection C, rebates must be paid in the large group, small group, and individual markets to the extent required by the ACA and Title 24-A M.R.S.A. § 4319.

C. In the individual market, if the carrier has elected the guaranteed loss ratio option under Subsection 8(H) and the minimum MLR pursuant to the ACA is less than 80%, then the carrier must also provide a modified reporting form based on an 80% minimum MLR.If the modified calculation indicates that rebates must be paid, the carrier must pay those rebate amounts rather than the rebate amounts, if any, indicated by the federal reporting form. Such rebates must be paid in the same manner as is required for rebates pursuant to the ACA.

Notes

02-031 C.M.R. ch. 940, § 14