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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10418 MLR Notice Individual Market to Subscribers Optional B	Form	Modified	Available
Form CMS-10418 MLR Notice 3 - Group Markets - Rebate to Subscribers	Form	Modified	Available
Form CMS-10418 MLR Notice 2 Group Markets - Rebate to Policyholder	Form	Modified	Available
Form CMS-10418 MLR Notice 1 - Individual Market to Subscribers	Form	Modified	Available
Form CMS-10418 Private Company for Disbursement of checks	Form	Modified	Repair queued
Form CMS-10418 Risk Corridors Plan Level Form	Form	Modified	Available
Form CMS-10418 MLR Form Instructions	Form and Instruction	Modified	Available
Form CMS-10418 MLR Reporting Form	Form and Instruction	Modified	Available
Form CMS-10418 Annual MLR Report	Form and Instruction	Modified	Repair queued
Comment Response Document.pdf	Supplementary Document	Uploaded 2024-02-13	Repair queued
MLR PRA Package Supporting Statement (002).docx	Supporting Statement A	Uploaded 2024-02-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201985	Retention of Records		Modified
201983	Private Company for Disbursement of checks	Form	Modified	MLR Notice Individual Market to Subscribers Optional B
201983	Private Company for Disbursement of checks	Form	Modified	MLR Notice 3 - Group Markets - Rebate to Subscribers
201983	Private Company for Disbursement of checks	Form	Modified	MLR Notice 2 Group Markets - Rebate to Policyholder
201983	Private Company for Disbursement of checks	Form	Modified	MLR Notice 1 - Individual Market to Subscribers
201983	Private Company for Disbursement of checks	Form	Modified
201983	Private Company for Disbursement of checks	Instruction	Modified
201982	Notice of rebates to Subscribers and Policyholders	Other-Template	Modified
201981	Annual MLR Report	Form	Modified	Risk Corridors Plan Level Form
201981	Annual MLR Report	Form and Instruction	Modified	MLR Form Instructions
201981	Annual MLR Report	Form and Instruction	Modified	MLR Reporting Form
201981	Annual MLR Report	Form and Instruction	Modified
201981	Annual MLR Report	Instruction	Modified

ICR Details

OMB Control No: 0938-1164	ICR Reference No: 202311-0938-016
Status: Active	Previous ICR Reference No: 202011-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CCIIO
Title: Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/24/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/13/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2027	36 Months From Approved	07/31/2024
Responses	5,197,932	0	9,166,846
Time Burden (Hours)	170,090	0	232,427
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1001(5) Name of Law: Bringing down the cost of health care coverage
   PL: Pub.L. 111 - 148 2718 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 40272	06/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 81418	11/22/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Annual MLR Report	CMS-10418, CMS-10418, CMS-10418	MLR Reporting Form ,   MLR Form Instructions ,   Risk Corridors Plan Level Form
Notice of rebates to Subscribers and Policyholders
Private Company for Disbursement of checks	CMS-10418, CMS-10418, CMS-10418, CMS-10418	MLR Notice 1 - Individual Market to Subscribers ,   MLR Notice 2 Group Markets - Rebate to Policyholder ,   MLR Notice 3 - Group Markets - Rebate to Subscribers ,   MLR Notice Individual Market to Subscribers Optional B
Retention of Records

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,197,932	9,166,846	0	0	-3,968,914	0
Annual Time Burden (Hours)	170,090	232,427	0	0	-62,337	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Based upon CMS’ experience in the MLR data collection and evaluation process, CMS is updating its annual burden hour estimates to reflect the actual numbers of submissions, rebates and rebate notices. The 2022 Annual Report reflects two new lines that will only be used by roughly 5 percent of issuers and a number of routine instruction updates and clarifications of the existing requirements that, together, are expected to have a negligible impact on the burden hours. In 2022, it is expected that issuers will submit fewer reports on average, and on average send fewer notices and rebate checks to policyholders and subscribers, which will overall decrease burden on issuers. It is estimated that there will be a net decrease in total burden from 232,427 to 170,091.

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Annual Cost to Federal Government: $114,978

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/13/2024

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