CMS-10418 MLR_Annual_Form

Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements

CMS 10418 MLR PRA Package MLR Form Template.xlsx

Annual MLR Report

OMB: 0938-1164

Document [xlsx]
Download: xlsx | pdf

Overview

Pt 1 - Summary of Data
Pt 2 - Premium and Claims
Pt 3 Expense Allocation
Pt 4 MLR and Rebate Calculation
Pt 5 Rebate Disbursement
Pt 6 Additional Responses
Attestation
Tables

Sheet 1: Pt 1 - Summary of Data

Department of Health and Human Services













PRA Disclosure Statement


























Medical Loss Ratio Reporting Form













According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information

























CGI_MLR_V5 Part 1 - Summary of Data













unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-1164.









































The time required to complete this information collection is estimated to average 64 hours or 3,840 minutes per response, including the time


























Group Affiliation:


Federal EIN :









to review instructions, search existing data resources, gather the data needed and complete and review the information collection. 








































If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form,


























Company Name:


A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)



please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


































































DBA / Marketing Name:


NAIC Group Code:

Business in the State of:

Not-For-Profit







































































Address:


NAIC Company Code:

Domiciliary State:

MLR Reporting Year:

































































































































































Health Insurance Coverage "Mini-Med" Expatriate Government Program Plans Other Health Business Aggregate 2% Rule Uninsured Plans





Individual Small Group Large Group Individual Small Group Large Group Small Group Large Group

Part 1 NOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW. NAIC Supp. Health Care Exhibit Line Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 12/31/12 Total as of 12/31/12 Total as of 12/31/12

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

1. Premium









































1.1 Total direct premium earned Pt 1, Ln 1.1







































1.2 Federal high risk pools Pt 1, Ln 1.2







































1.3 State high risk pools Pt 1, Ln 1.3







































1.4 Net assumed less ceded reinsurance premium earned (exclude amounts already reported in Line 1.1) Pt 1, Ln 1.9







































1.5 Other adjustments due to MLR calculations - premium Pt 1, Ln 1.10







































1.6 Risk revenue Pt 1, Ln 1.11

















































































2. Claims









































2.1 Total incurred claims Pt 1, Ln 5.0







































2.2 Prescription drugs
(informational only; already included in total incurred claims above)		 Pt 1, Ln 2.2







































2.3 Pharmaceutical rebates
(informational only; already excluded from total incurred claims above)		 Pt 1, Ln 2.3







































2.4 State stop loss, market stabilization and claim/census based assessments
(informational only; already excluded from total incurred claims above)		 Pt 1, Ln 2.4







































2.5 Net assumed less ceded claims incurred (exclude amounts already reported in Line 2.1) Pt 1, Ln 5.1







































2.6 Other adjustments due to MLR calculations – claims incurred Pt 1, Ln 5.2







































2.7 Rebates paid Pt 1, Ln 5.3







































2.8 Estimated rebates unpaid at the end of the prior MLR reporting year Pt 1, Ln 5.4







































2.9 Estimated rebates unpaid at the end of the current MLR reporting year Pt 1, Ln 5.5







































2.10 Fee-for-service and co-pay revenue (net of expenses) Pt 1, Ln 5.6

















































































3. Federal and State Taxes and Licensing or Regulatory Fees









































3.1 Federal taxes and assessments incurred by the reporting issuer during the MLR reporting year









































3.1 a Federal income taxes deductible from premium in MLR calculations









































3.1 b Other Federal Taxes (other than income tax) and assessments deductible from premium








































3.2 State insurance, premium and other taxes incurred by the reporting issuer during the MLR reporting year (deductible from premium in MLR calculation)









































3.2 a State income, excise, business, and other taxes









































3.2 b State premium taxes









































3.2 c Community benefit expenditures deductible from premium in MLR calculations Pt 1, Ln 1.6a







































3.3 Regulatory authority licenses and fees Pt 1, Ln 1.7

















































































4. Health Care Quality Improvement Expenses Incurred









































4.1 Improve health outcomes Pt 1, Ln 6.1







































4.2 Activities to prevent hospital readmission Pt 1, Ln 6.2







































4.3 Improve patient safety and reduce medical errors Pt 1, Ln 6.3







































4.4 Wellness and health promotion activities Pt 1, Ln 6.4







































4.5 Health information technology expenses related to healthcare quality Pt 1, Ln 6.5







































4.6 Allowable Implementation ICD-10 expenses (not to exceed 0.3% of premium) Pt 1, Ln 16a

















































































5. Non-Claims Costs









































5.1 Cost containment expenses not included in quality improvement expenses in Section 4 Pt 1, Ln 8.1







































5.2 All other claims adjustment expenses Pt 1, Ln 8.2







































5.3 Direct sales salaries and benefits Pt 1, Ln 10.1







































5.4 Agents and brokers fees and commissions Pt 1, Ln 10.2







































5.5 Other taxes









































5.5a Taxes and assessments not excluded from premium (not reported in Section 3 or Line 9)









































5.5b Fines and penalties of regulatory authorities (not reported in Line 3.3)








































5.6 Other general and administrative expenses








































5.7 Community benefit expenditures (informational only; include amounts reported in Sections 3 & 5) Pt 1, Ln 10.4a







































5.8 ICD-10 implementation expenses (informational only; include amounts reported in Sections 4 & 5) Pt 1, Ln 16

















































































6. Income from fees of uninsured plans
Pt 1, Ln 12






































7. Other Indicators or information









































7.1 Number of policies/certificates Pt 1 Other, Ln 1







































7.2 Number of covered lives Pt 1 Other, Ln 2







































7.3 Number of groups Pt 1 Other, Ln 3







































7.4 Member months Pt 1 Other, Ln 4







































7.5 Number of life-years











































Grand Total as of 12/31/12 for ALL markets in col. 1-35















































































8. Net investment income and other gain / (loss)
Pt 1, Ln 13






































9. Other Federal income taxes (excluding taxes on line 3.1 above)
Pt 1, Ln 14

















































































Cell Keys:










































Blank cells require input from issuer








































Grey cells require no data input – input will result in an upload failure









































Pink cells require no data input - locked down









































Blue cells require a calculation by the issuer








































Yellow cells require a calculation by the issuer that is dependent on issuer size






































Sheet 2: Pt 2 - Premium and Claims
Department of Health and Human Services








































Medical Loss Ratio Reporting Form








































Part 2 - Premium and Claims


















































































Group Affiliation:


Federal EIN :













































































Company Name:


A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)





































































DBA / Marketing Name:


NAIC Group Code:

Business in the State of:

Not-For-Profit





































































Address:


NAIC Company Code:

Domiciliary State:

MLR Reporting Year:





























































































































































Health Insurance Coverage "Mini-Med" Expatriate Government Program Plans Other Health Business Aggregate 2% Rule Uninsured Plans




Individual Small Group Large Group Individual Small Group Large Group Small Group Large Group
Part 2 NOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW. NAIC Supp. Health Care Exhibit Line Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 3/31/13 Dual Contract (Included in 3/31/13) Deferred PY1 (Add) Deferred CY (Subtract) Total as of 12/31/12 Total as of 12/31/12 Total as of 12/31/12 Total as of 12/31/12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
1. Premium:








































1.1 Direct premium written Pt 2, Ln 1.1






































1.2 Unearned premium prior year Pt 2, Ln 1.2






































1.3 Unearned premium MLR Reporting year Pt 2, Ln 1.3






































1.4 Experience rating refunds (rate credits) paid








































1.4a Experience rating refunds, with all incurred dates, paid in the MLR reporting year Pt 2, Ln 1.5







































1.4b Experience rating refunds associated with premium earned only in the reporting year and paid through 3/31 of the following year







































1.5 Reserve for experience rating refunds (rate credits) MLR Reporting year Pt 2, Ln 1.6






































1.6 Reserve for experience rating refunds (rate credits) prior year Pt 2, Ln 1.7






































1.7 Premium balances written off Pt 2, Ln 1.9






































1.8 Group conversion charges Pt 2, Ln 1.10






































1.9 Premium ceded under 100% reinsurance (informational only; excluded from Line 1.1)







































1.10 Premium assumed under 100% reinsurance (informational only; already included in Line 1.1)
















































































2. Claims:








































2.1 Claims Paid








































2.1a Claims paid during the MLR reporting year regardless of incurred date Pt 2, Ln 2.1







































2.1b Claims incurred only during the MLR reporting year, paid through 3/31 of the following year







































2.2 Direct claim liability








































2.2a Liability as of 12/31 of MLR reporting year for all claims regardless of incurred date Pt 2, Ln 2.2







































2.2b Liability for claims incurred only during the MLR reporting year, calculated as of 3/31 of the following year







































2.3 Direct claim liability prior year Pt 2, Ln 2.3






































2.4 Direct claim reserves








































2.4a Reserves as of 12/31 of MLR reporting year for all claims regardless of incurred date Pt 2, Ln 2.4







































2.4b Reserves for claims incurred only during the MLR reporting year, calculated as of 3/31 of the following year







































2.5 Direct claim reserves prior year Pt 2, Ln 2.5






































2.6 Direct contract reserves








































2.6a Direct contract reserves 12/31 column Pt 2, Ln 2.6







































2.6b Direct contract reserves 3/31, dual contract, deferred columns







































2.7 Direct contract reserves prior year Pt 2, Ln 2.7






































2.8 Experience rating refunds (rate credits) paid








































2.8a Experience rating refunds, with all incurred dates, paid in the MLR reporting year Pt 2, Ln 2.8







































2.8b Experience rating refunds associated with premium earned only in the reporting year and paid through 3/31 of the following year







































2.9 Reserve for experience rating refunds (rate credits)








































2.9a Reserved in MLR reporting year regardless of incurred date Pt 2, Ln 2.9







































2.9b Reserves specific to the MLR reporting year through 3/31 of the following year







































2.10 Reserve for experience rating refunds (rate credits) prior year Pt 2, Ln 2.10






































2.11 Incurred medical incentive pool and bonuses








































2.11a Paid medical incentive pools and bonuses MLR Reporting year Pt 2, Ln 2.11a







































2.11b Accrued medical incentive pools and bonuses MLR Reporting year Pt 2, Ln 2.11b







































2.11c Accrued medical incentive pools and bonuses prior year Pt 2, Ln 2.11c






































2.12 Net healthcare receivables








































2.12a Healthcare receivables MLR Reporting year Pt 2, Ln 2.12a







































2.12b Healthcare receivables prior year Pt 2, Ln 2.12b






































2.13 Contingent benefit and lawsuit reserves







































2.14 Group conversion charges Pt 2, Ln 2.13






































2.15 Blended rate adjustment Pt 2, Ln 2.14






































2.16 Total incurred claims Pt 2, Ln 2.15






































2.17 Allowable fraud reduction expense (the smaller of Lines 2.17a or 2.17b) Pt 1, Ln 4







































2.17a Total fraud reduction expense Pt 3, Col 7, Ln 1.11/ 2.11/3.11/5.11/6.11







































2.17b Total fraud recoveries that reduced paid claims in Line 2.1 Pt 2, Ln 3

























































































































Cell Keys:









































Blank cells require input from issuer







































Grey cells require no data input – input will result in an upload failure








































Pink cells require no data input - locked down








































Blue cells require a calculation by the issuer







































Yellow cells require a calculation by the issuer that is dependent on issuer size






































Sheet 3: Pt 3 Expense Allocation
Department of Health and Human Services

Federal EIN :

DBA / Marketing Name:



Medical Loss Ratio Reporting Form







Part 3 - Expense Allocation

A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)








Group Affiliation:

NAIC Group Code:

Business in the State of:

Not-For-Profit








Company Name:

NAIC Company Code:

Domiciliary State:

MLR Reporting Year:






























Description of Expense Element (by Type) NEW Detailed Description of Expense Allocation Methods
1 2 3
1. Incurred Claims





























































2. Federal and State Taxes and Licensing or Regulatory Fees

2.a Federal taxes and assessments



















2.b State insurance, premium and other taxes



















2.c Community benefit expenditures



















2.d Regulatory authority licenses and fees



















3. Quality Improvement Expenses

3.a Improve health outcomes































3.b Activities to prevent hospital readmission































3.c Improve patient safety and reduce medical errors































3.d Wellness and health promotion activities































3.e Health Information Technology expenses related to healthcare quality































3.f Allowable ICD-10 Expenses































4. Non-Claims costs

4.a Cost containment expenses not included in quality improvement expenses































4.b All other claims adjustment expenses































4.c Direct sales salaries and benefits































4.d Agents and brokers fees and commissions































4.e Other taxes































4.f Other general and administrative expenses































4.g Community benefit expenditures































4.h ICD-10 implementation expenses










































Cell Keys:









Blank cells require input from issuer








Grey cells require no data input – input will result in an upload failure









Pink cells require no data input - locked down









Blue cells require a calculation by the issuer








Yellow cells require a calculation by the issuer that is dependent on issuer size








Sheet 4: Pt 4 MLR and Rebate Calculation
Department of Health and Human Services


Federal EIN :

DBA / Marketing Name:


























Medical Loss Ratio Reporting Form































Part 4 - MLR and Rebate Calculation


A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)























































Group Affiliation:


NAIC Group Code:

Business in the State of:

Not-For-Profit





















































Company Name:


NAIC Company Code:

Domiciliary State:

MLR Reporting Year:



























































































Health Insurance Coverage "Mini-Med" Expatriate



Individual Small Group Large Group Individual Small Group Large Group Small Group Large Group
Part 4 NOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW. PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total PY2 PY1 CY Total
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
1. Medical Loss Ratio Numerator

































1.1 Adjusted incurred claims as reported on MLR Form for prior year(s)
































1.2 Adjusted incurred claims as of 3/31 of the year following the MLR reporting year
































1.3 Quality improvement expenses
































1.4 MLR rebates paid based on 2011 or 2012 experience
































1.5 MLR numerator
































1.6 MLR numerator "Mini-Med" and Expatriate
(MLR numerator x adjustment factor)

































































2. Medical Loss Ratio Denominator

































2.1 Premium earned including Federal and State high risk programs
































2.2 Federal and State taxes and licensing or regulatory fees
































2.3 MLR Denominator (Line 2.1 - Line 2.2)


































































3. Credibility Adjustment

































3.1 Life Years to determine credibility
































3.2 Base credibility factor
































3.3 Average deductible
































3.4 Deductible factor
































3.5 Credibility adjustment (Lines 3.2 x 3.4 (do not round))


































































4. MLR Calculation (for issuers with at least 1,000 life years in the Total column of Line 3.1)
































4.1 Preliminary MLR

































4.1a Preliminary MLR (Lines 1.5 / 2.3)

































4.1b Preliminary MLR: "Mini-Med" and Expatriate (Lines 1.6 / 2.3)
































4.2 Credibility adjustment (Line 3.5, if applicable)
































4.3 Credibility-adjusted MLR (Lines 4.1a or 4.1b + 4.2)


































































5. Rebate Calculation

































5.1 MLR standard
































5.2 Credibility-adjusted MLR (Line 4.3)
































5.3 Adjusted earned premium less Federal and State taxes and licensing or regulatory fees ((Line 2.3, column CY only)
































5.4 Rebate amount if credibility-adjusted MLR is less than MLR standard (Lines (5.1 - 5.2) X 5.3)





































































































Cell Keys:


































Blank cells require input from issuer
































Grey cells require no data input – input will result in an upload failure

































Pink cells require no data input - locked down

































Blue cells require a calculation by the issuer

































Yellow cells require a calculation by the issuer that is dependent on issuer size
































Sheet 5: Pt 5 Rebate Disbursement
Department of Health and Human Services

Federal EIN :

DBA / Marketing Name:



Medical Loss Ratio Reporting Form







Part 5 - Rebate Disbursement

A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)








Group Affiliation:

NAIC Group Code:

Business in the State of:

Not-For-Profit







Company Name:

NAIC Company Code:

Domiciliary State:

MLR Reporting Year:




















Health Insurance Coverage "Mini-Med" Expatriate


Individual Small Group Large Group Individual Small Group Large Group Small Group Large Group


1 2 3 4 5 6 7 8
1. Number of policies / certificates (from Part 1 Line 7.1)



















2. Number of policyholders/subscribers owed rebates









2.a Number of group policyholders being paid a rebate









2.b Number of subscribers being paid a rebate









2.c Number of group policyholders whose rebate is de minimis









2.d Number of subscribers whose rebate is de minimis



















3. Total amount of rebates









3.a Total amount of rebates (from Part 4, Line 5.4)









3.b Amount of de minimis rebates









3.c Amount of rebates being paid by premium credit









3.d Amount of rebates being paid by lump-sum reimbursement



















4. Prior MLR year rebates









4.a Amount of rebates paid in prior MLR year









4.b Percentage of notices sent timely to individual policy subscribers or group policyholders owed a rebate









4.c Percentage of notices sent timely to subscribers of group policies owed a rebate









4.d Percentage of rebates paid timely to individual policy subscribers or group policyholders owed a rebate









4.e Percentage of rebates paid timely to subscribers of group policies owed a rebate









4.f Amount of unclaimed rebates from prior MLR reporting year









4.g Describe methods used to locate policyholders/subscribers for prior MLR reporting year's unclaimed rebates:


4.h Describe disbursement of prior MLR reporting year's unclaimed rebates:























Cell Keys:










Blank cells require input from issuer








Grey cells require no data input – input will result in an upload failure









Pink cells require no data input - locked down









Blue cells require a calculation by the issuer








Yellow cells require a calculation by the issuer that is dependent on issuer size







Sheet 6: Pt 6 Additional Responses
Department of Health and Human Services
Federal EIN :

DBA / Marketing Name:



Medical Loss Ratio Reporting Form






Part 6 - Additional Responses
A.M. Best Number:

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)







Group Affiliation:
NAIC Group Code:

Business in the State of:

Not-For-Profit







Company Name:
NAIC Company Code:

Domiciliary State:

MLR Reporting Year:




























Tax Rate







1. If amount reported in Part 1 Line 3.2c, Community benefit expenditures, provide the state premium tax rate used to determine the reported amount:


















2. If the issuer reported amounts in Part 2 Line 2.15 Blended rate adjustment provide the affiliate(s) name(s) with whom blended rate adjustments were made.







Name of Affiliate




















































































































3. If the issuer reported amounts in the Dual Contract 3/31 Columns provide the affiliate(s) name(s) with whom experience is being reported.







Name of Affiliate




















































































































4. If the issuer entered into any 100% assumptive reinsurance agreements with a novation during the MLR reporting year, provide the name(s) of the entity(ies) with whom the agreement was (were) made and the effective date of the novation.





Name of Entity with whom Agreement was made Effective Date of Novation







































































































5. If the Issuer novated any business in the MLR reporting year effective during the reporting year provide the name of the entity to whom the business was sold or transferred and the date of the sale or transfer.





Name of Entity to whom business was sold or transferred Effective Date of sale or transfer































































































6. If the issuer has any 100% indemnity reinsurance and administrative agreements effective prior to March 23, 2010, for which the assuming entity is responsible for 100% of the ceding entity's financial risk and takes on all of the administration of the block, report the name(s) of the entity(ies) that is (are) reporting the experience related to such business.












































Cell Keys:








Blank cells require input from issuer







Grey cells require no data input – input will result in an upload failure








Pink cells require no data input - locked down








Blue cells require a calculation by the issuer







Yellow cells require a calculation by the issuer that is dependent on issuer size







Sheet 7: Attestation
Department of Health and Human Services










Medical Loss Ratio Attestation






















Group Affiliation:

Federal EIN :

Issuer ID:

Merge Markets - Ind/SmGrp (MA Only)









Company Name:

A.M. Best Number:

Business in the State of:

Not-for-Profit









DBA/Marketing Name:

NAIC Group Code:

Domiciliary State:

MLR Reporting Year:









Address:

NAIC Company Code:








































Attestation Statement






















The officers of this reporting issuer being duly sworn, each attest that he/she is the described officer of the reporting issuer, and that this MLR Reporting Form, the Company/Issuer Associations, and any supplemental submission that the issuer includes are full and true statements of all the elements included therein for the MLR reporting year stated above, and that the MLR Reporting Form has been completed in accordance with the Department of Health and Human Services’ reporting instructions, according to the best of his/her information, knowledge and belief. Furthermore, the scope of this attestation by the described officer includes any related electronic filings and postings for the MLR reporting year stated above and which are required by Department of Health and Human Services under section 2718 of the Public Health Service Act and implementing regulation.
























____________________________ 










Chief Executive Officer/President






















____________________________  










Chief Financial Officer










Sheet 8: Tables
Table 1
Table 3
Table 4
Table 5
Base Credibility Adjustment Factors
State and Territory Names
Reporting Years
Yes/No
Life Years Base credibility factor
Alaska
2011
Yes
- 0.0%
Alabama
2012
No
1,000 8.3%
Arkansas
2013

2,500 5.2%
American Samoa
2014

5,000 3.7%
Arizona
2015

10,000 2.6%
California
2016

25,000 1.6%
Canada
2017

50,000 1.2%
Colorado
2018

75,000 0.0%
Connecticut
2019




District of Columbia
2020




Delaware
2021

Table 2
Florida
2022

Deductible Factors
Georgia
2023

Average Health Plan Deductible Deductible factor
Guam
2024

$0 1.000
Hawaii
2025

$2,500 1.164
Iowa
2026

$5,000 1.402
Idaho
2027

$10,000 1.736
Illinois
2028




Indiana
2029




Kansas
2030




Kentucky
2031




Louisiana
2032




Massachusetts
2033




Maryland
2034




Maine
2035




Michigan
2036




Minnesota
2037




Missouri
2038




MP
2039




Mississippi
2040




Montana
2041




North Carolina
2042




North Dakota
2043




Nebraska
2044




New Hampshire
2045




New Jersey
2046




New Mexico
2047




Nevada
2048




New York
2049




Ohio
2050




Oklahoma
2051




Oregon
2052




Other Territories
2053




Pennsylvania
2054




Puerto Rico
2055




Rhode Island
2056




South Carolina
2057




South Dakota
2058




Tennessee
2059




Texas
2060




Utah






Virginia






Virgin Islands






Vermont






Washington






Wisconsin






West Virginia






Wyoming






Grand Total



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