2020 ACA Risk-Sharing Provisions & SHCE Preparation

Virtual Training Seminar
4.5 CPE Credits Available
Presenters: Colleen Gingrich/Bruce Cromartie
October 7, 2020
9:00am Eastern
(8:00am Central)
October 14, 2020
9:00am Mountain
(8:00am Pacific)

9:00am – 9:15am

Welcome and Introductory Comments

9:15am – 10:45am

Preparation and Filing NAIC Supplemental Health Care Exhibit

This session provides instructions on completing the various parts of the Supplemental Health Care Exhibit (SHCE), Parts 1, 2, 3 and the SHCE Expense Allocation Report. In this session the purpose and intent of the SHCE, filing requirements, allocation and reporting methodologies and an explanation of the lines of business columnar definitions and changes to the 2020 SHCE are addressed.

10:45am – 11:00am


11:00am – 12:00pm

Commercial and Medicare MLR Filing and Reporting Requirements

This session provides an overview of the 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.

12:00pm – 12:45pm

Accounting, Reporting, Disclosure ACA Risk Adjustment, and Risk Corridors Programs

This session provides an overview and discussion of the Affordable Care Act Risk Risk-Sharing Programs as well as a legislative update on the ACA. This session addresses the statutory accounting and reporting for these Risk-Sharing Programs.

The following SSAPs are addressed in this session:

  • SSAP No. 54R – Individual and Group A&H Contracts, Revised
  • SSAP No. 107 – Risk-Sharing Provisions of the Affordable Care Act

The Schedules and Exhibits covered in this session include:

  • Underwriting and Investment Exhibit, Part 2D – Aggregate Reserve for Accident and Health Contracts
  • Page 2 – Asset Page
  • Page 3 – Liabilities, Capital and Surplus
  • Page 4 – Statement of Revenue and Expenses
  • U&I Exhibit Part 3 – Analysis of Expenses
  • Notes to the Financial Statement

12:45pm – 1:00pm

Closing Remarks and Adjournment