Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations (CMS-10361)

Section 2718 of the Public Health Service Act (PHS Act) and its implementing regulation at 45 CFR Part 158 requires health insurance issuers (issuers) offering group or individual health insurance coverage to provide rebates to enrollees in any State where an issuer does not meet the medical loss ratio (MLR) standard specified by section 2718 for the applicable market (individual, small group, or large group). Section 2718(d) of the PHS Act provides that the Secretary may adjust the MLR standard in the individual market. Title 45 CFR Part 158 sets forth the framework for a State to request such an adjustment and the process and criteria for the Secretary to determine whether to grant a State’s request. Subpart C of 45 CFR Part 158 specifies the information that the State must provide to support its request, and the criteria that HHS may consider in making a determination. HHS must obtain such information in order to ascertain whether an adjustment to the MLR standard would have a reasonable likelihood of helping stabilize the individual market in the requesting State.

The latest form for Medical Loss Ratio (IFR) Information Collection Requirements and Supporting Regulations (CMS-10361) expires 2021-08-31 and can be found here.

Waiver Application

Federal Enterprise Architecture: Health - Health Care Services