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

OMB 0938-1164

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.

The latest form for Medical Loss Ratio Annual Reports, MLR Notices, and Recordkeeping Requirements (CMS-10418) expires 2020-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10418 Private Company for Disbursement of checks Form
Form CMS-10418 Annual MLR Report Form and Instruction
Comment Response Document.pdf Supplementary Document
MLR PRA Package Supporting Statement (002).docx Supporting Statement A
Retention of Records
Private Company for Disbursement of checks Form
Notice of rebates to Subscribers and Policyholders Other-Template
Annual MLR Report Form and Instruction

All Historical Document Collections

202311-0938-016 Approved with change	Revision of a currently approved collection	2024-02-13
202011-0938-007	Reinstatement without change of a previously approved collection	2020-11-13
202006-0938-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-06-16
201707-0938-016 Approved without change	Revision of a currently approved collection	2017-07-31
201607-0938-002 Approved without change	Revision of a currently approved collection	2016-07-08
201504-0938-016 Approved without change	Revision of a currently approved collection	2015-04-29
201402-0938-006 Approved with change	Revision of a currently approved collection	2014-02-11
201304-0938-002 Approved without change	Revision of a currently approved collection	2013-04-05
201204-0938-004 Approved with change	New collection (Request for a new OMB Control Number)	2012-04-17

OMB Details

Annual MLR Report

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10418	MLR Form Instructions	Fillable Fileable	Form and instruction
Form CMS-10418	Risk Corridors Plan Level Form	Fillable Fileable	Form
Form CMS-10418	MLR Reporting Form	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.