2021 Supplemental Health Care Exhibit and CMS Medical Loss Ratio Preparation Virtual Seminar
October 7, 2021
All Times Eastern Standard Time
Presenters: Karen Foster/Brian Neader
Agenda
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10:30am – 10:45am |
Welcome and Introduction |
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10:45am – 11:30am |
Overview of NAIC Supplemental Health Care Exhibit |
| This session provides an overview of the various parts of the Supplemental Health Care Exhibit (SHCE), Parts 1, 2, 3, the SHCE Expense Allocation Report. In this session the purpose and intent of the SHCE is addressed including an overview of the filing requirements, SHCE allocation and reporting methodologies, lines of business columnar definitions and changes to the 2020 SHCE. | |
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11:30am – 12:15pm |
Supplemental Health Care Exhibit – Part 2 |
| This session provides instructions on completing Part 2 of the SHCE. Part 2 develops “Health Premiums Earned” and “Direct Claims Incurred” which are key items in developing the denominator and numerator used in the PLMR calculation found in Part 1. Part 2 is also used to identify Fraud and Abuse Recoveries that Reduced Paid Claims which is another key component in the PMLR calculation. | |
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12:15pm – 12:30pm |
Break |
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12:30pm – 1:15pm |
Supplemental Health Care Exhibit – Part 3 and Expense Allocation Report |
| This session provides instructions on completing Part 3 and the Expense Allocation Report of the SHCE. Part 3 identifies and allocates “health care quality expenses” as reported in Part 1 of the SHCE. This session addresses how to reallocate administrative expenses reported as claims adjustment and general administrative expenses as reported in the U&I Exhibit – Part 3 to the appropriate lines of business and to the new health care quality expense categories.
This session also addresses the preparation and filing of the Expense Allocation Report made to the |
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1:15pm – 2:30pm |
Supplemental Health Care Exhibit – Part 1 |
| This session provides instructions on completing Part 1 of the SHCE including general rules of allocation for certain items. Part 1 develops the Medical Loss Ratio and calculates a gain or loss by the lines of business defined in the columns. Part 1 includes 16 line items that include the key elements in developing the PMLR. | |
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2:30pm – 2:45pm |
Break |
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2:45pm – 3:45pm |
Commercial and Medicare MLR Filing and Reporting Requirements |
| This session provides an overview of the additional filing and reporting requirements for the CMS’s MLR Reporting Forms for Commercial and Medicare Products including a discussion of how data reported in the SHCE is used to calculate the rebates in the CMS Reporting Forms. | |
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3:45pm – 4:15pm |
Update on Accounting, Reporting, Disclosure ACA Risk Sharing Programs |
| This session provides an overview and discussion of the Affordable Care Act Risk Risk-Sharing Programs including new accounting and reporting guidance regarding State ACA reinsurance programs pursuant to the SSAP No. 107 – Risk-Sharing Provisions of the Affordable Care Act. |
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4:15pm – 4:30pm |
Closing Remarks and Adjournment |