Part 158 — Issuer Use of Premium Revenue: Reporting and Rebate Requirements
Subpart A — Disclosure and Reporting
- § 158.110— Reporting requirements related to premiums and expenditures.
- § 158.120— Aggregate reporting.
- § 158.121— Newer experience.
- § 158.130— Premium revenue.
- § 158.140— Reimbursement for clinical services provided to enrollees.
- § 158.150— Activities that improve health care quality.
- § 158.151— Expenditures related to Health Information Technology and meaningful use requirements.
- § 158.160— Other non-claims costs.
- § 158.161— Reporting of Federal and State licensing and regulatory fees.
- § 158.162— Reporting of Federal and State taxes.
- § 158.170— Allocation of expenses.
Subpart B — Calculating and Providing the Rebate
- § 158.210— Minimum medical loss ratio.
- § 158.211— Requirement in States with a higher medical loss ratio.
- § 158.220— Aggregation of data in calculating an issuer's medical loss ratio.
- § 158.221— Formula for calculating an issuer's medical loss ratio.
- § 158.230— Credibility adjustment.
- § 158.231— Life-years used to determine credible experience.
- § 158.232— Calculating the credibility adjustment.
- § 158.240— Rebating premium if the applicable medical loss ratio standard is not met.
- § 158.241— Form of rebate.
- § 158.242— Recipients of rebates.
- § 158.243— <em>De minimis</em> rebates.
- § 158.244— Unclaimed rebates.
- § 158.250— Notice of rebates.
- § 158.251— Notice of MLR information.
- § 158.260— Reporting of rebates.
- § 158.270— Effect of rebate payments on solvency.
Subpart C — Potential Adjustment to the MLR for a State's Individual Market
- § 158.301— Standard for adjustment to the medical loss ratio.
- § 158.310— Who may request adjustment to the medical loss ratio.
- § 158.311— Duration of adjustment to the medical loss ratio.
- § 158.320— Information supporting a request for adjustment to the medical loss ratio.
- § 158.321— Information regarding the State's individual health insurance market.
- § 158.322— Proposal for adjusted medical loss ratio.
- § 158.323— State contact information.
- § 158.330— Criteria for assessing request for adjustment to the medical loss ratio.
- § 158.340— Process for submitting request for adjustment to the medical loss ratio.
- § 158.341— Treatment as a public document.
- § 158.342— Invitation for public comments.
- § 158.343— Optional State hearing.
- § 158.344— Secretary's discretion to hold a hearing.
- § 158.345— Determination on a State's request for adjustment to the medical loss ratio.
- § 158.346— Request for reconsideration.
- § 158.350— Subsequent requests for adjustment to the medical loss ratio.
Subpart D — HHS Enforcement
Subpart E — Additional Requirements on Issuers
Subpart F — Federal Civil Penalties
- § 158.601— General rule regarding the imposition of civil penalties.
- § 158.602— Basis for imposing civil penalties.
- § 158.603— Notice to responsible entities.
- § 158.604— Request for extension.
- § 158.605— Responses to allegations of noncompliance.
- § 158.606— Amount of penalty—general.
- § 158.607— Factors HHS uses to determine the amount of penalty.
- § 158.608— Determining the amount of the penalty—mitigating circumstances.
- § 158.609— Determining the amount of penalty—aggravating circumstances.
- § 158.610— Determining the amount of penalty—other matters as justice may require.
- § 158.611— Settlement authority.
- § 158.612— Limitations on penalties.
- § 158.613— Notice of proposed penalty.
- § 158.614— Appeal of proposed penalty.
- § 158.615— Failure to request a hearing.