Annual MLR Report

Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1164 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10418 Annual MLR Report Form and Instruction
CMS-10418 - 2016-Risk-Corridor-Plan-Level-Instructions-x.pdf Instruction
CMS-10418 MLR Reporting Form CMS-10418 - 2016-MLR-Reporting-Form-2017-07.xlsx Form and Instruction
CMS-10418 MLR Form Instructions CMS-10418 - 2016 MLR Form Instructions 2017-07.pdf Form and Instruction
CMS-10418 Risk Corridors Plan Level Form CMS-10418 - 2016-Risk-Corridors-Plan-Level-Form-x.xlsx Form

Information Collection (IC) Details

IC Title:	Annual MLR Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 158

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10418	MLR Reporting Form	CMS-10418 - 2016-MLR-Reporting-Form-2017-07.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10418	MLR Form Instructions	CMS-10418 - 2016 MLR Form Instructions 2017-07.pdf	Yes	Yes	Fillable Fileable
Instruction			CMS-10418 - 2016-Risk-Corridor-Plan-Level-Instructions-x.pdf	Yes	Yes	Paper Only
Form	CMS-10418	Risk Corridors Plan Level Form	CMS-10418 - 2016-Risk-Corridors-Plan-Level-Form-x.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 545	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,442	-376	2,818
Annual IC Time Burden (Hours)	151,037	-28,241	179,278
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.