CMS Bulletin Re-excluding Agent and Broker Fees or Commissions

Date: May 27, 2015
From: Samara Lorenz, Acting Director, Oversight Group
Title: Insurance Standards Bulletin Series—INFORMATION
Subject: CCIIO Technical Guidance (CCIIO 2015—0001): Questions and Answers Regarding the Medical Loss Ratio (MLR) Reporting and Rebate Requirements

I. Purpose
The purpose of this bulletin is to provide guidance regarding: the limited circumstances in which a health insurance issuer may, for MLR reporting purposes, exclude agent and broker fees or commissions from earned premium under 45 CFR §158.130; and, to whom a health insurance issuer must provide MLR rebates payable under section 2718 of the Public Health Service Act (PHS Act), as added by the Patient Protection and Affordable Care Act (Affordable Care Act), and the implementing regulation at 45 CFR §158.240, when a portion or all of the premium is paid with advance payments of the premium tax credit.

This Bulletin provides MLR guidance on the following topics:
• Earned premium and agent and broker fees and commissions
• Recipients of MLR rebates

For entire bulletin: .pdf | Centers for Medicare and Medicaid Services