Notice of Rebate to Enrollees

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

OMB: 0938-1164

IC ID: 201983

Information Collection (IC) Details

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Notice of Rebate to Enrollees
 
No Modified
 
Mandatory
 
45 CFR 158

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10418 MLR Notice 1 - Individual Market to Subscribers MLR Notice 1 Individual Market - to Subscribers Optional-A.docx Yes Yes Fillable Printable
Form CMS-10418 MLR Notice 2 Group Markets - Rebate to Policyholder MLR Notice 2 Group Markets - Rebate to Policyholder.pdf Yes Yes Fillable Printable
Form CMS-10418 MLR Notice 3 - Group Markets - Rebate to Subscribers MLR Notice 3 Group Markets - Rebate to Subscribers.pdf Yes Yes Fillable Printable
Instruction MLR Notice Instructions Optional-A-B.pdf Yes Yes Paper Only
Form CMS-10418 MLR Notice Individual Market to Subscribers Optional B MLR Notice 1 Individual Market - to Subscribers Optional-B.pdf Yes Yes Fillable Printable

Health Health Care Services

 

41 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 640,912 0 0 0 0 640,912
Annual IC Time Burden (Hours) 16,848 0 0 825 0 16,023
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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