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{"sheet":"Start Here","index":0,"n_rows":29,"n_cols":2,"rows_kept":29,"cut":false,"hidden":false,"merged":[]}
[]
[null,"    INSTRUCTIONS FOR USING THE FORMULA REFERENCE AND FORMULA CALCULATOR WITH THE 2013 MLR ANNUAL REPORTING FORM"]
[]
[null,"The 2013 MLR Annual Reporting Form does not automatically perform the MLR and rebate calculations. When a completed form is submitted, CMS' Health Insurance Oversight System (HIOS) will alert companies if their submitted values do not match HIOS calculated values.\n"]
[null,"Companies may do the MLR and rebate calculations themselves, following the 2013 MLR Annual Reporting Form Filing Instructions.  For the user's convenience, all 2013 MLR and rebate formulas are summarized on the Formula Reference tab of this file.\n"]
[null,"Companies may also use the Formula Calculator included in the tabs of this file that are marked Part 1 Summary of Data, Part 2 Premium and Claims, and Part 4 MLR and Rebate Calculation to perform and/or verify their MLR and rebate calculations for the 2013 MLR reporting year.  To use the Formula Calculator, please follow Steps 1−5 below.  For your convenience if you choose this option, this Formula Calculator can also copy all data entered in this file into the HIOS template file you specify.  You may need to enable macros to use the optional Formula Calculator copy functionality; please contact your IT department for assistance."]
[]
[null,"Step 1.  Companies must download and use the HIOS template file(s) from the HIOS MLR module.  Do not use the MLR Form file posted on the MLR page of CCIIO's website, or this Formula Calculator file, to file MLR data in HIOS."]
[]
[null,"Step 2.  Make sure that this Formula Calculator file is placed in and opened from the same folder as the destination HIOS template file."]
[]
[null,"Step 3."]
[null,"(a) Do one of the following:"]
[null,"(i) Populate the blank cells on Parts 1, 2, and the relevant portions of Part 4 of the HIOS template file, and copy these data into the corresponding cells of this Formula Calculator file; OR"]
[null,"(ii) Populate the blank cells on Parts 1, 2, and the relevant portions of Part 4 of this Formula Calculator file, as you would populate the HIOS template file."]
[null,"(b) Make sure that all data fields that require entry (blank cells), except for those that require calculations (blue cells), are populated, where appropriate.  "]
[null,"(c) You do not need to populate the header information of this Formula Calculator file, except for the \"Federal Tax Exempt\" field.  \nHowever, if using a template for Massachusetts, ensure that \"Business in the State of\" is set to \"Massachusetts\" and \"Merge Markets - Ind/SmGrp\" option is set to \"Yes\" on the \"Pt 1 Summary of Data\" tab of this file."]
[null,"(d) To ensure that the Formula Calculator functions correctly, do NOT insert or delete rows or columns anywhere in this file."]
[]
[null,"Step 4. "]
[null,"(a) Do one of the following:"]
[null,"(i) Use the calculated fields in Parts 1, 2, and 4 of this file to complete the corresponding fields of your HIOS template file.  Make sure to use \"Paste Special: Values\" option in order to avoid pasting formulas into the HIOS template file; OR "]
[null,"(ii) To have the Formula Calculator copy the data into your HIOS template file, enter the destination HIOS template filename in the green box below, and click the \"Copy to HIOS Template\" button.  Please note that if you use the Formula Calculator copy functionality, all fields (blank and blue cells) will be copied over."]
[]
[null,"MLR_Template_Sample_State.xls"]
[]
[]
[]
[null,"Step 5. Review the HIOS template file to ensure that it has been correctly and accurately populated before saving it.  Remember to complete the remaining Parts, as required."]

{"sheet":"Formula Reference","index":1,"n_rows":29,"n_cols":2,"rows_kept":29,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["2013 MLR Annual Reporting Form: Formula Resource"]
["2013 Form Line","2013 Form Calculation References"]
["Part 1 Line 1.1\n(Total direct premium earned)","Part 2 Lines 1.1 + 1.2 – 1.3 – 1.7 + 1.8"]
["Part 1 Line 2.1 \n(Total incurred claims)","Part 2 Line 2.16\nPlease note that on the 2011 MLR Form, this line was equal to Part 2 Lines 2.16 + 2.17"]
["Part 1 Line 2.11\n(Allowable fraud reduction expense)","Part 2 Line 2.17"]
["Part 1 Line 7.5\n(Life-years)","Part 1 Line 7.4 / 12"]
["Part 2 Line 2.16\n(Total incurred claims)","Column \"Total as of 12/31/12\": \nPart 2 Lines 2.1a + 2.2a – 2.3 + 2.4a – 2.5 + 2.6a – 2.7 + 2.8a + 2.9a – 2.10 + 2.11a + 2.11b – 2.11c – 2.12a + 2.12b + 2.13 + 2.14 + 2.15\n\nAll other columns (\"3/31/13\", \"Dual Contract\", \"Deferred PY1\", \"Deferred CY\"):\nPart 2 Lines 2.1b + 2.2b + 2.4b + 2.6b – 2.7 + 2.8b + 2.9b + 2.11a + 2.11b – 2.12a + 2.13 + 2.14 + 2.15"]
["Part 2 Line 2.17\n(Allowable fraud reduction expense)","The lesser of: Part 2 Line 2.17a or 2.17b"]
["Part 4 Line 1.1\n(Adjusted incurred claims as reported on MLR Form for prior year(s))","Column \"PY2\":\n2011 MLR Form, Part 1 Line 2.1, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\"\n\nColumn \"PY1\":\n2012 MLR Form, (Part 1 Line 2.1, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\") + \n                            (Part 2 Line 2.17, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\")"]
["Part 4 Line 1.2\n(Adjusted incurred claims as of 3/31 of the year following the MLR reporting year)","Column \"PY2\":\nAdjusted claims incurred in the 2011 MLR reporting year, restated as of 3/31/14\n\nColumn \"PY1\":\nAdjusted claims incurred in the 2012 MLR reporting year, restated as of 3/31/14\n\nColumn \"CY\":\n(Part 1 Line 2.1, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 2.11, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")\n\nColumn \"Total\": \nPart 4 Line 1.2, Columns PY2 + PY1 + CY"]
["Part 4 Line 1.3\n(Quality improvement expenses)","Column \"PY2\":\n2011 MLR Form, Part 1 Line 4.6, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\"\n\nColumn \"PY1\":\n2012 MLR Form, (Part 1 Line 4.1, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.2, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            (Part 1 Line 4.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.4, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            (Part 1 Line 4.5, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.6, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")\n\nColumn \"CY\":\n(Part 1 Line 4.1, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.2, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 4.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.4, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 4.5, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 4.6, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")\n\nColumn \"Total\": \nPart 4 Line 1.3, Columns PY2 + PY1 + CY"]
["Part 4 Line 1.4\n(MLR rebates based on 2011 experience)","Column \"PY2\":\n2011 MLR Form, Part 5 Line 5.4\n\nColumn \"PY1\":\n2012 MLR Form, Part 4 Line 5.4\n\nColumn \"Total\": \nPart 4 Line 1.4, Columns PY2 + PY1"]
["Part 4 Line 1.5\n(MLR numerator)","Individual, Small Group, and Large Group Columns \"PY2\", \"PY1\", \"CY\", except MA merged markets:\nPart 4, Lines 1.2 + 1.3\nIndividual and Small Group Columns \"PY2\", \"PY1\", \"CY\", if Business State is MA: \n(Part 4, Individual Column, Lines 1.2 + 1.3) + (Part 4, Small Group Column, Lines 1.2 + 1.3)\n\nIndividual, Small Group, and Large Group Columns \"Total\", except MA merged markets:\nPart 4, Lines 1.2 + 1.3 + 1.4\nIndividual and Small Group Columns \"Total\", if Business State is MA: \n(Part 4, Individual Column, Lines 1.2 + 1.3 + 1.4) + (Part 4, Small Group Column, Lines 1.2 + 1.3 + 1.4)"]
["Part 4 Line 1.6\n(MLR numerator: Mini-Med and Student Health Plans)","Mini-Med Column \"PY2\", except MA merged markets:\n2.0 x (Part 4 Lines 1.2 + 1.3)\nMini-Med Individual and Small Group Columns \"PY2\", if Business State is MA: \n2.0 x [(Part 4, Mini-Med Individual Column, Lines 1.2 + 1.3) + (Part 4, Mini-Med Small Group Column, Lines 1.2 + 1.3)]\n\nMini-Med Column \"PY1\", except MA merged markets:\n1.75 x (Part 4 Lines 1.2 + 1.3)\nMini-Med Individual and Small Group Columns \"PY1\", if Business State is MA: \n1.75 x [(Part 4, Mini-Med Individual Column, Lines 1.2 + 1.3) + (Part 4, Mini-Med Small Group Column, Lines 1.2 + 1.3)]\n\nMini-Med Column \"CY\", except MA merged markets:\n1.5 x (Part 4 Lines 1.2 + 1.3)\nMini-Med Individual and Small Group Columns \"CY\", if Business State is MA: \n1.5 x [(Part 4, Mini-Med Individual Column, Lines 1.2 + 1.3) + (Part 4, Mini-Med Small Group Column, Lines 1.2 + 1.3)]\n\nMini-Med Column \"Total\", except MA merged markets:\n1.5 x (Part 4 Lines 1.2 + 1.3 + 1.4)\nMini-Med Individual and Small Group Columns \"Total\", if Business State is MA: \n1.5 x [(Part 4, Mini-Med Individual Column, Lines 1.2 + 1.3 + 1.4) + (Part 4, Mini-Med Small Group Column, Lines 1.2 + 1.3 + 1.4)]\n\nStudent Health Plans columns, Grand Total template only:\n1.15 x (Part 4 Column \"Total\", Lines 1.2 + 1.3 + 1.4)"]
["Part 4 Line 2.1\n(Premium earned including Federal and State high risk programs)","Column \"PY2\":\n2011 MLR Form, Part 1 Line 1.4, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\"\n\nColumn \"PY1\":\n2012 MLR Form, (Part 1 Line 1.1, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            (Part 1 Line 1.2, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            (Part 1 Line 1.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")  \n\nColumn \"CY\":\n(Part 1 Line 1.1, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 1.2, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 1.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") –\n Part 4 Line 6.1a\n\nColumn \"Total\": \nPart 4 Line 2.1, Columns PY2 + PY1 + CY"]
["Part 4 Line 2.2\n(Federal and State taxes and licensing or regulatory fees)","Column \"PY2\":\n2011 MLR Form, Part 1 Line 3.4, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\"\n\nColumn \"PY1\":\n2012 MLR Form, (Part 1 Line 3.1a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.1b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            (Part 1 Line 3.2a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n                            [The greater of: (Part 1 Line 3.2b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") or \n                                                      (Part 1 Line 3.2c, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")] + \n                            (Part 1 Line 3.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")\n\nColumn \"CY\":\nFederal Tax-Exempt Issuers:\n(Part 1 Line 3.1a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.1b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 3.1c, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.2a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 3.2b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.2c, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 3.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") – Part 4 Line 6.1b\n\nNon Federal Tax-Exempt Issuers:\n(Part 1 Line 3.1a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.1b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 3.1c, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + (Part 1 Line 3.2a, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n[The greater of: (Part 1 Line 3.2b, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") or \n                          (Part 1 Line 3.2c, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")] + \n(Part 1 Line 3.3, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") – Part 4 Line 6.1b\n\nColumn \"Total\": \nPart 4 Line 2.2, Columns PY2 + PY1 + CY"]
["Part 4 Line 2.3\n(MLR denominator)","Individual, Small Group, and Large Group Columns, except MA merged markets:\nPart 4, Lines 2.1 – 2.2\n\nIndividual and Small Group Columns, if Business State is MA: \n(Part 4, Individual Column, Lines 2.1 – 2.2) + (Part 4, Small Group Column, Lines 2.1 – 2.2)"]
["Part 4 Line 3.1\n(Life-years to determine credibility)","Column \"PY2\", except MA merged markets:\n2011 MLR Form, Part 1 Line 11.5, Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\"\nColumn \"PY2\", Individual and Small Group Columns, if Business State is MA: \n2011 MLR Form, (Part 1 Line 11.5, Individual Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\") + \n                             (Part 1 Line 11.5, Small Group Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\")\n\nColumn \"PY1\", except MA merged markets:\n2012 MLR Form, Part 1 Line 7.5, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\" \nColumn \"PY1\", Individual and Small Group Columns, if Business State is MA: \n2012 MLR Form, (Part 1 Line 7.5, Individual Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\") + \n                             (Part 1 Line 7.5, Small Group Columns \"3/31/YY\" + \"Deferred PY\" – \"Deferred CY\")\n\nColumn \"CY\", except MA merged markets:\nPart 1 Line 7.5, Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\" \nColumn \"CY\", Individual and Small Group Columns, if Business State is MA: \n(Part 1 Line 7.5, Individual Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\") + \n(Part 1 Line 7.5, Small Group Columns \"3/31/13\" + \"Deferred PY1\" – \"Deferred CY\")\n\nColumn \"Total\": \nPart 4 Line 3.1, Columns PY2 + PY1 + CY"]
["Part 4 Line 3.2\n(Base credibility factor)","Column \"Total\": \n   ● if Column \"Total\" Part 4 Line 3.1 < 1,000 or ≥ 75,000: \n      0 (zero)\n   ● if Column \"PY2\" Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1, and \n         Column \"PY1\" Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1, and\n         Column \"CY\"   Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1:\n      0 (zero)\n   ● if 1,000 ≤ Column \"Total\" Part 4 Line 3.1 < 75,000 and none of the conditions above apply: \n      Calculate using linear interpolation and Table 1 (do not round)\n\nTable 1:\nLife-Years    Base credibility factor\n   <1,000          0.0%\n     1,000          8.3%\n     2,500          5.2%\n     5,000          3.7%\n   10,000          2.6%\n   25,000          1.6%\n   50,000          1.2%\n ≥75,000          0.0%\n\nLinear Interpolation Formula (x = life-years, y = base credibility factor) where x2 = Part 4 Line 3.1 Column \"Total\": \ny2 = y1 + [(y3 – y1) / (x3 – x1)] * (x2 – x1)\n\nLinear Interpolation Example:\nThe base credibility factor for 16,525 life-years can be calculated as follows:\n2.6% + [(1.6% – 2.6%) / (25,000 – 10,000)] x (16,525 – 10,000) = 2.6% – 0.435% = 2.165%\n(Note: do not round the base credibility factor when calculating the MLR.  Add the unrounded credibility factor multiplied by the unrounded deductible factor to the unrounded preliminary MLR from Part 4 Line 4.1 Total Column, then round the resulting credibility-adjusted MLR to 3 decimal places (e.g. 80.1%) and enter on Part 4 Line 4.3."]
["Part 4 Line 3.4\n(Deductible factor)","Column \"Total\": \n   ● if Part 4 Line 3.3 < 2,500: \n      1.000\n   ● if Part 4 Line 3.3 ≥ 10,000: \n      1.736\n   ● if 2,500 ≤ Part 4 Line 3.3 < 10,000: \n      Calculate using linear interpolation and Table 2 (do not round).\n\nTable 2:\nAverage Deductible    Deductible factor\n    <2,500                         1.000\n      2,500                         1.164\n      5,000                         1.402\n  ≥10,000                         1.736\n\nLinear Interpolation Formula (x = average health plan deductible, y = deductible factor) where x2 = Part 4 Line 3.3 Column \"Total\": \ny2 = y1 + [(y3 – y1) / (x3 – x1)] * (x2 – x1)\n\nLinear interpolation example:\nThe deductible factor for a $3,500 average deductible can be calculated as follows:\n1.164 + [(1.402 – 1.164) / (5,000 – 2,500)] x (3,500 – 2,500) = 1.164 + 0.0952 = 1.2592\n(Note: do not round the credibility factor multiplied by the deductible factor when calculating the MLR.  Add the unrounded credibility factor multiplied by the unrounded deductible factor to the unrounded preliminary MLR from Part 4 Line 4.1, then round the result to 3 decimal places (e.g. 80.1%) and enter on Part 4 Line 4.3."]
["Part 4 Line 3.5\n(Credibility adjustment)","Column \"Total\": \n   ● if Column \"Total\" Part 4 Line 3.1 < 1,000 or ≥ 75,000: \n      0 (zero)\n   ● if Column \"PY2\" Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1, and \n         Column \"PY1\" Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1, and\n         Column \"CY\"   Part 4 Line 3.1 ≥ 1,000 and Line 4.1a or 4.1b < Line 5.1: \n      0 (zero)\n   ● if 1,000 ≤ Column \"Total\" Part 4 Line 3.1 < 75,000 and none of the conditions above apply: \n      Part 4 Lines 3.2 x 3.4 (do not round)"]
["Part 4 Line 4.1a\n(Preliminary MLR)","Columns \"PY2\", \"PY1\", \"CY\", \"Total\": \n   ● if Part 4 Line 3.1 < 1,000: \n      blank\n   ● if Part 4 Line 3.1 ≥ 1,000: \n      Part 4 Lines 1.5 / 2.3 (do not round)"]
["Part 4 Line 4.1b\n(Preliminary MLR: Mini-Med and Student Health Plans)","Columns \"PY2\", \"PY1\", \"CY\", \"Total\": \n   ● if Part 4 Line 3.1 < 1,000: \n      blank\n   ● if Part 4 Line 3.1 ≥ 1,000: \n      Part 4 Lines 1.6 / 2.3 (do not round)"]
["Part 4 Line 4.2\n(Credibility adjustment)","Part 4, Line 3.5"]
["Part 4 Line 4.3\n(Credibility-adjusted MLR)","Column \"Total\": \n   ● if Column \"Total\" Part 4 Line 3.1 < 1,000: \n      blank\n   ● if Column \"Total\" Part 4 Line 3.1 ≥ 1,000: \n      Health Insurance Coverage columns:    Part 4 Lines 4.1a + 4.2\n      Mini-Med and Student Health columns:  Part 4 Lines 4.1b + 4.2\n   (round to three decimal places, e.g. 0.801 or 80.1%)"]
["Part 4 Line 5.1\n(MLR standard)","Standards deviating from 80% and 85% are highlighted in red.\n\n                     Individual market          Small Group market          Large Group market\n                     2011  2012  2013           2011  2012  2013              2011  2012  2013\nGA                 70%   75%   80%           80%   80%   80%              85%   85%   85%\nIA                   67%   75%   80%           80%   80%   80%              85%   85%   85%\nKY, NC, NV   75%   80%   80%           80%   80%   80%              85%   85%   85%\nMA                 88%   90%   90%           88%   90%   90%              85%   85%   85%\nME                 65%   65%   80%           80%   80%   80%              85%   85%   85%\nNH                 72%   75%   80%           80%   80%   80%              85%   85%   85%\nNY                 82%   82%   82%           82%   82%   82%              85%   85%   85%\nAll others       80%   80%   80%           80%   80%   80%              85%   85%   85%"]
["Part 4 Line 5.2\n(Credibility-adjusted MLR)","Part 4, Line 4.3"]
["Part 4 Line 5.3\n(Adjusted earned premium less Federal and State taxes and licensing or regulatory fees)","Column \"Total\": \n   ● if Column \"Total\" Part 4 Line 3.1 < 1,000: \n      blank\n   ● if Column \"Total\" Part 4 Line 3.1 ≥ 1,000: \n      Part 4 Column \"CY\", Lines 2.1 – 2.2 (if negative, set to 0 (zero))"]
["Part 4 Line 5.4\n(Rebate amount)","Column \"Total\": \n   ● if Column \"Total\" Part 4 Line 3.1 < 1,000: \n      0 (zero)\n   ● if Column \"Total\" Part 4 Line 3.1 ≥ 1,000 and Part 4 Line 5.2 ≥ Line 5.1: \n      0 (zero)\n   ● if Column \"Total\" Part 4 Line 3.1 ≥ 1,000 and Part 4 Line 5.2 < Line 5.1: \n      Part 4 (Lines 5.1 – 5.2) x Line 5.3"]

{"sheet":"Pt 1 Summary of Data","index":2,"n_rows":87,"n_cols":48,"rows_kept":87,"cut":false,"hidden":false,"merged":[[14,44,15,44],[15,26,15,28],[14,47,15,47],[14,46,15,46],[14,45,15,45],[7,5,7,6],[9,5,9,6],[11,5,11,6],[14,5,14,19],[14,29,14,38],[14,20,14,28],[15,10,15,14],[15,15,15,19],[7,11,7,12],[9,11,9,12],[7,8,7,9],[9,8,9,9],[86,2,86,3],[83,2,83,3],[5,11,5,12],[15,39,15,43],[14,39,14,43],[77,5,78,5],[11,8,11,9],[11,11,11,12],[5,5,5,6],[16,1,17,3],[16,4,17,4],[15,29,15,33],[15,34,15,38],[15,20,15,22],[15,23,15,25],[15,5,15,9]]}
[null,"Department of Health and Human Services"]
[null,"Medical Loss Ratio Reporting Form - Formula Tool"]
[null,"Part 1 - Summary of Data"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Federal Tax Exempt "]
[null,null,null,null,null,null,null,null,null,null,null,"No"]
[null,null,null,null,null,null,null,null,null,null,null,"Merge Markets - Ind/SmGrp"]
[null,null,null,null,null,null,null,null,null,null,null,"No"]
[null,null,null,null,null,null,null,null,"Business in the State of:"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"MLR Reporting Year:"]
[null,null,null,null,null,null,null,null,null,null,null,2013]
[]
[]
[null,null,null,null,null,"Health Insurance Coverage",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mini-Med Plans",null,null,null,null,null,null,null,null,"Expatriate Plans",null,null,null,null,null,null,null,null,null,"Student Health Plans",null,null,null,null,"Government Program Plans","Other Health Business","Aggregate 2% Rule","Uninsured Plans"]
[null,null,null,null,null,"Individual",null,null,null,null,"Small Group",null,null,null,null,"Large Group",null,null,null,null,"Individual",null,null,"Small Group",null,null,"Large Group",null,null,"Small Group",null,null,null,null,"Large Group",null,null,null,null,"Individual"]
[null,"Part 1\nNOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW.",null,null,"NAIC Supp. Health Care Exhibit Line","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 12/31/13","Total as of 12/31/13","Total as of 12/31/13"]
[null,null,null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]
[null,"1.","Premium"]
[null,null,1.1000000000000001,"Total direct premium earned","Pt 1, Ln 1.1",{"$f":"'Pt 2 Premium and Claims'!F20+'Pt 2 Premium and Claims'!F21-'Pt 2 Premium and Claims'!F22-'Pt 2 Premium and Claims'!F28+'Pt 2 Premium and Claims'!F29","v":0},{"$f":"'Pt 2 Premium and Claims'!G20+'Pt 2 Premium and Claims'!G21-'Pt 2 Premium and Claims'!G22-'Pt 2 Premium and Claims'!G28+'Pt 2 Premium and Claims'!G29","v":0},{"$f":"'Pt 2 Premium and Claims'!H20+'Pt 2 Premium and Claims'!H21-'Pt 2 Premium and Claims'!H22-'Pt 2 Premium and Claims'!H28+'Pt 2 Premium and Claims'!H29","v":0},{"$f":"'Pt 2 Premium and Claims'!I20+'Pt 2 Premium and Claims'!I21-'Pt 2 Premium and Claims'!I22-'Pt 2 Premium and Claims'!I28+'Pt 2 Premium and Claims'!I29","v":0},{"$f":"'Pt 2 Premium and Claims'!J20+'Pt 2 Premium and Claims'!J21-'Pt 2 Premium and Claims'!J22-'Pt 2 Premium and Claims'!J28+'Pt 2 Premium and Claims'!J29","v":0},{"$f":"'Pt 2 Premium and Claims'!K20+'Pt 2 Premium and Claims'!K21-'Pt 2 Premium and Claims'!K22-'Pt 2 Premium and Claims'!K28+'Pt 2 Premium and Claims'!K29","v":0},{"$f":"'Pt 2 Premium and Claims'!L20+'Pt 2 Premium and Claims'!L21-'Pt 2 Premium and Claims'!L22-'Pt 2 Premium and Claims'!L28+'Pt 2 Premium and Claims'!L29","v":0},{"$f":"'Pt 2 Premium and Claims'!M20+'Pt 2 Premium and Claims'!M21-'Pt 2 Premium and Claims'!M22-'Pt 2 Premium and Claims'!M28+'Pt 2 Premium and Claims'!M29","v":0},{"$f":"'Pt 2 Premium and Claims'!N20+'Pt 2 Premium and Claims'!N21-'Pt 2 Premium and Claims'!N22-'Pt 2 Premium and Claims'!N28+'Pt 2 Premium and Claims'!N29","v":0},{"$f":"'Pt 2 Premium and Claims'!O20+'Pt 2 Premium and Claims'!O21-'Pt 2 Premium and Claims'!O22-'Pt 2 Premium and Claims'!O28+'Pt 2 Premium and Claims'!O29","v":0},{"$f":"'Pt 2 Premium and Claims'!P20+'Pt 2 Premium and Claims'!P21-'Pt 2 Premium and Claims'!P22-'Pt 2 Premium and Claims'!P28+'Pt 2 Premium and Claims'!P29","v":0},{"$f":"'Pt 2 Premium and Claims'!Q20+'Pt 2 Premium and Claims'!Q21-'Pt 2 Premium and Claims'!Q22-'Pt 2 Premium and Claims'!Q28+'Pt 2 Premium and Claims'!Q29","v":0},{"$f":"'Pt 2 Premium and Claims'!R20+'Pt 2 Premium and Claims'!R21-'Pt 2 Premium and Claims'!R22-'Pt 2 Premium and Claims'!R28+'Pt 2 Premium and Claims'!R29","v":0},{"$f":"'Pt 2 Premium and Claims'!S20+'Pt 2 Premium and Claims'!S21-'Pt 2 Premium and Claims'!S22-'Pt 2 Premium and Claims'!S28+'Pt 2 Premium and Claims'!S29","v":0},{"$f":"'Pt 2 Premium and Claims'!T20+'Pt 2 Premium and Claims'!T21-'Pt 2 Premium and Claims'!T22-'Pt 2 Premium and Claims'!T28+'Pt 2 Premium and Claims'!T29","v":0},{"$f":"'Pt 2 Premium and Claims'!U20+'Pt 2 Premium and Claims'!U21-'Pt 2 Premium and Claims'!U22-'Pt 2 Premium and Claims'!U28+'Pt 2 Premium and Claims'!U29","v":0},{"$f":"'Pt 2 Premium and Claims'!V20+'Pt 2 Premium and Claims'!V21-'Pt 2 Premium and Claims'!V22-'Pt 2 Premium and Claims'!V28+'Pt 2 Premium and Claims'!V29","v":0},{"$f":"'Pt 2 Premium and Claims'!W20+'Pt 2 Premium and Claims'!W21-'Pt 2 Premium and Claims'!W22-'Pt 2 Premium and Claims'!W28+'Pt 2 Premium and Claims'!W29","v":0},{"$f":"'Pt 2 Premium and Claims'!X20+'Pt 2 Premium and Claims'!X21-'Pt 2 Premium and Claims'!X22-'Pt 2 Premium and Claims'!X28+'Pt 2 Premium and Claims'!X29","v":0},{"$f":"'Pt 2 Premium and Claims'!Y20+'Pt 2 Premium and Claims'!Y21-'Pt 2 Premium and Claims'!Y22-'Pt 2 Premium and Claims'!Y28+'Pt 2 Premium and Claims'!Y29","v":0},{"$f":"'Pt 2 Premium and Claims'!Z20+'Pt 2 Premium and Claims'!Z21-'Pt 2 Premium and Claims'!Z22-'Pt 2 Premium and Claims'!Z28+'Pt 2 Premium and Claims'!Z29","v":0},{"$f":"'Pt 2 Premium and Claims'!AA20+'Pt 2 Premium and Claims'!AA21-'Pt 2 Premium and Claims'!AA22-'Pt 2 Premium and Claims'!AA28+'Pt 2 Premium and Claims'!AA29","v":0},{"$f":"'Pt 2 Premium and Claims'!AB20+'Pt 2 Premium and Claims'!AB21-'Pt 2 Premium and Claims'!AB22-'Pt 2 Premium and Claims'!AB28+'Pt 2 Premium and Claims'!AB29","v":0},{"$f":"'Pt 2 Premium and Claims'!AC20+'Pt 2 Premium and Claims'!AC21-'Pt 2 Premium and Claims'!AC22-'Pt 2 Premium and Claims'!AC28+'Pt 2 Premium and Claims'!AC29","v":0},null,null,null,null,null,null,null,null,null,null,{"$f":"'Pt 2 Premium and Claims'!AN20+'Pt 2 Premium and Claims'!AN21-'Pt 2 Premium and Claims'!AN22-'Pt 2 Premium and Claims'!AN28+'Pt 2 Premium and Claims'!AN29","v":0},{"$f":"'Pt 2 Premium and Claims'!AO20+'Pt 2 Premium and Claims'!AO21-'Pt 2 Premium and Claims'!AO22-'Pt 2 Premium and Claims'!AO28+'Pt 2 Premium and Claims'!AO29","v":0},{"$f":"'Pt 2 Premium and Claims'!AP20+'Pt 2 Premium and Claims'!AP21-'Pt 2 Premium and Claims'!AP22-'Pt 2 Premium and Claims'!AP28+'Pt 2 Premium and Claims'!AP29","v":0},{"$f":"'Pt 2 Premium and Claims'!AQ20+'Pt 2 Premium and Claims'!AQ21-'Pt 2 Premium and Claims'!AQ22-'Pt 2 Premium and Claims'!AQ28+'Pt 2 Premium and Claims'!AQ29","v":0},{"$f":"'Pt 2 Premium and Claims'!AR20+'Pt 2 Premium and Claims'!AR21-'Pt 2 Premium and Claims'!AR22-'Pt 2 Premium and Claims'!AR28+'Pt 2 Premium and Claims'!AR29","v":0},{"$f":"'Pt 2 Premium and Claims'!AS20+'Pt 2 Premium and Claims'!AS21-'Pt 2 Premium and Claims'!AS22-'Pt 2 Premium and Claims'!AS28+'Pt 2 Premium and Claims'!AS29","v":0},{"$f":"'Pt 2 Premium and Claims'!AT20+'Pt 2 Premium and Claims'!AT21-'Pt 2 Premium and Claims'!AT22-'Pt 2 Premium and Claims'!AT28+'Pt 2 Premium and Claims'!AT29","v":0},{"$f":"'Pt 2 Premium and Claims'!AU20+'Pt 2 Premium and Claims'!AU21-'Pt 2 Premium and Claims'!AU22-'Pt 2 Premium and Claims'!AU28+'Pt 2 Premium and Claims'!AU29","v":0}]
[null,null,1.2,"Federal high risk pools","Pt 1, Ln 1.2"]
[null,null,1.3,"State high risk pools","Pt 1, Ln 1.3"]
[null,null,1.4,"Net assumed less ceded reinsurance premium earned (exclude amounts already reported in Line 1.1)","Pt 1, Ln 1.9"]
[null,null,1.5,"Other adjustments due to MLR calculations - premium","Pt 1, Ln 1.10"]
[null,null,1.6,"Risk revenue","Pt 1, Ln 1.11"]
[]
[null,"2.","Claims"]
[null,null,2.1,"Total incurred claims (MLR Form Part 2, Line 2.16)","Pt 1, Ln 5.0",{"$f":"'Pt 2 Premium and Claims'!F66","v":0},{"$f":"'Pt 2 Premium and Claims'!G66","v":0},{"$f":"'Pt 2 Premium and Claims'!H66","v":0},{"$f":"'Pt 2 Premium and Claims'!I66","v":0},{"$f":"'Pt 2 Premium and Claims'!J66","v":0},{"$f":"'Pt 2 Premium and Claims'!K66","v":0},{"$f":"'Pt 2 Premium and Claims'!L66","v":0},{"$f":"'Pt 2 Premium and Claims'!M66","v":0},{"$f":"'Pt 2 Premium and Claims'!N66","v":0},{"$f":"'Pt 2 Premium and Claims'!O66","v":0},{"$f":"'Pt 2 Premium and Claims'!P66","v":0},{"$f":"'Pt 2 Premium and Claims'!Q66","v":0},{"$f":"'Pt 2 Premium and Claims'!R66","v":0},{"$f":"'Pt 2 Premium and Claims'!S66","v":0},{"$f":"'Pt 2 Premium and Claims'!T66","v":0},{"$f":"'Pt 2 Premium and Claims'!U66","v":0},{"$f":"'Pt 2 Premium and Claims'!V66","v":0},{"$f":"'Pt 2 Premium and Claims'!W66","v":0},{"$f":"'Pt 2 Premium and Claims'!X66","v":0},{"$f":"'Pt 2 Premium and Claims'!Y66","v":0},{"$f":"'Pt 2 Premium and Claims'!Z66","v":0},{"$f":"'Pt 2 Premium and Claims'!AA66","v":0},{"$f":"'Pt 2 Premium and Claims'!AB66","v":0},{"$f":"'Pt 2 Premium and Claims'!AC66","v":0},null,null,null,null,null,null,null,null,null,null,{"$f":"'Pt 2 Premium and Claims'!AN66","v":0},{"$f":"'Pt 2 Premium and Claims'!AO66","v":0},{"$f":"'Pt 2 Premium and Claims'!AP66","v":0},{"$f":"'Pt 2 Premium and Claims'!AQ66","v":0},{"$f":"'Pt 2 Premium and Claims'!AR66","v":0},{"$f":"'Pt 2 Premium and Claims'!AS66","v":0},{"$f":"'Pt 2 Premium and Claims'!AT66","v":0},{"$f":"'Pt 2 Premium and Claims'!AU66","v":0}]
[null,null,2.2000000000000002,"Prescription drugs\n(informational only; already included in total incurred claims above)","Pt 1, Ln 2.2"]
[null,null,2.2999999999999998,"Pharmaceutical rebates\n(informational only; already excluded from total incurred claims above)","Pt 1, Ln 2.3"]
[null,null,2.4,"State stop loss, market stabilization and claim/census based assessments\n(informational only; already excluded from total incurred claims above)","Pt 1, Ln 2.4"]
[null,null,2.5,"Net assumed less ceded claims incurred (exclude amounts already reported in Line 2.1)","Pt 1, Ln 5.1"]
[null,null,2.6,"Other adjustments due to MLR calculations – claims incurred","Pt 1, Ln 5.2"]
[null,null,2.7,"Rebates paid","Pt 1, Ln 5.3"]
[null,null,2.8,"Estimated rebates unpaid at the end of the previous MLR reporting year","Pt 1, Ln 5.4"]
[null,null,2.9,"Estimated rebates unpaid at the end of the MLR reporting year","Pt 1, Ln 5.5"]
[null,null,"2.10","Fee-for-service and co-pay revenue (net of expenses)","Pt 1, Ln 5.6"]
[null,null,"2.11","Allowable fraud reduction expenses (MLR Form Part 2, Line 2.17)","Pt 1, Ln 4",{"$f":"'Pt 2 Premium and Claims'!F67","v":0},{"$f":"'Pt 2 Premium and Claims'!G67","v":0},{"$f":"'Pt 2 Premium and Claims'!H67","v":0},{"$f":"'Pt 2 Premium and Claims'!I67","v":0},{"$f":"'Pt 2 Premium and Claims'!J67","v":0},{"$f":"'Pt 2 Premium and Claims'!K67","v":0},{"$f":"'Pt 2 Premium and Claims'!L67","v":0},{"$f":"'Pt 2 Premium and Claims'!M67","v":0},{"$f":"'Pt 2 Premium and Claims'!N67","v":0},{"$f":"'Pt 2 Premium and Claims'!O67","v":0},{"$f":"'Pt 2 Premium and Claims'!P67","v":0},{"$f":"'Pt 2 Premium and Claims'!Q67","v":0},{"$f":"'Pt 2 Premium and Claims'!R67","v":0},{"$f":"'Pt 2 Premium and Claims'!S67","v":0},{"$f":"'Pt 2 Premium and Claims'!T67","v":0},{"$f":"'Pt 2 Premium and Claims'!U67","v":0},{"$f":"'Pt 2 Premium and Claims'!V67","v":0},{"$f":"'Pt 2 Premium and Claims'!W67","v":0},{"$f":"'Pt 2 Premium and Claims'!X67","v":0},{"$f":"'Pt 2 Premium and Claims'!Y67","v":0},{"$f":"'Pt 2 Premium and Claims'!Z67","v":0},{"$f":"'Pt 2 Premium and Claims'!AA67","v":0},{"$f":"'Pt 2 Premium and Claims'!AB67","v":0},{"$f":"'Pt 2 Premium and Claims'!AC67","v":0},null,null,null,null,null,null,null,null,null,null,{"$f":"'Pt 2 Premium and Claims'!AN67","v":0},{"$f":"'Pt 2 Premium and Claims'!AO67","v":0},{"$f":"'Pt 2 Premium and Claims'!AP67","v":0},{"$f":"'Pt 2 Premium and Claims'!AQ67","v":0},{"$f":"'Pt 2 Premium and Claims'!AR67","v":0},{"$f":"'Pt 2 Premium and Claims'!AS67","v":0},{"$f":"'Pt 2 Premium and Claims'!AT67","v":0},{"$f":"'Pt 2 Premium and Claims'!AU67","v":0}]
[]
[null,"3.","Federal and State Taxes and Licensing or Regulatory Fees"]
[null,null,3.1,"Federal taxes and assessments incurred by the reporting issuer during the MLR reporting year ","Pt 1, Ln 1.5"]
[null,null,null,"  3.1 a  Federal income taxes deductible from premium in MLR calculations "]
[null,null,null,"  3.1 b  Patient Centered Outcomes Research Institute (PCORI) Fee "]
[null,null,null,"  3.1 c  Other Federal Taxes (other than income tax) and assessments deductible from premium"]
[null,null,3.2,"State insurance, premium and other taxes incurred by the reporting issuer during the MLR reporting year (deductible from premium in MLR calculation)","Pt 1, Ln 1.6"]
[null,null,null,"  3.2 a   State income, excise, business, and other taxes"]
[null,null,null,"  3.2 b   State premium taxes "]
[null,null,null,"  3.2 c   Community benefit expenditures deductible from premium in MLR calculations","Pt 1, Ln 1.6a"]
[null,null,3.3,"Regulatory authority licenses and fees","Pt 1, Ln 1.7"]
[]
[null,"4.","Health Care Quality Improvement Expenses Incurred "]
[null,null,4.0999999999999996,"Improve health outcomes","Pt 1, Ln 6.1"]
[null,null,4.2,"Activities to prevent hospital readmission","Pt 1, Ln 6.2"]
[null,null,4.3,"Improve patient safety and reduce medical errors","Pt 1, Ln 6.3"]
[null,null,4.4000000000000004,"Wellness and health promotion activities","Pt 1, Ln 6.4"]
[null,null,4.5,"Health information technology expenses related to improving health care quality","Pt 1, Ln 6.5"]
[null,null,4.5999999999999996,"Allowable Implementation ICD-10 expenses (not to exceed 0.3% of premium)","Pt 1, Ln 16a"]
[]
[null,"5.","Non-Claims Costs "]
[null,null,5.0999999999999996,"Cost containment expenses not included in quality improvement expenses in Section 4","Pt 1, Ln 8.1"]
[null,null,5.2,"All other claims adjustment expenses","Pt 1, Ln 8.2"]
[null,null,5.3,"Direct sales salaries and benefits","Pt 1, Ln 10.1"]
[null,null,5.4,"Agents and brokers fees and commissions","Pt 1, Ln 10.2"]
[null,null,5.5,"Other taxes"]
[null,null,null,"5.5a   Taxes and assessments (exclude amounts reported in Section 3 or Line 10) \n"]
[null,null,null,"5.5b   Fines and penalties of regulatory authorities (exclude amounts reported in Line 3.3)"]
[null,null,5.6,"Other general and administrative expenses"]
[null,null,5.7,"Community benefit expenditures (informational only; include amounts reported in Lines 3.2c and 5.6)","Pt 1, Ln 10.4a"]
[null,null,5.8,"ICD-10 implementation expenses (informational only; include amounts reported in Lines 4.6 and 5.6)","Pt 1, Ln 16"]
[]
[null,"6.","Income from fees of uninsured plans",null,"Pt 1, Ln 12"]
[null,"7.","Other Indicators or information "]
[null,null,7.1,"Number of policies/certificates","Pt 1 Other, Ln 1"]
[null,null,7.2,"Number of covered lives","Pt 1 Other, Ln 2"]
[null,null,7.3,"Number of groups","Pt 1 Other, Ln 3"]
[null,null,7.4,"Member months","Pt 1 Other, Ln 4"]
[null,null,7.5,"Number of life-years",null,{"$f":"F76/12","v":0},{"$f":"G76/12","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,null,null,null,null,null,null,null,null,null,null,0,0,0,0,0,0,0,0,0]
[null,null,null,null,null,"Grand Total as of 12/31/12 for ALL markets in col. 1-43"]
[]
[null,"8.","Net investment income and other gain / (loss) ",null,"Pt 1, Ln 13"]
[null,"9.","Other Federal income taxes (exclude taxes on Line 3.1a, 3.1b, and 3.1c) ",null,"Pt 1, Ln 14"]
[]
[null,"Cell Keys:"]
[null,null,"Blank cells require input from issuer"]
[null,null,"Grey cells require no data input – input will result in an upload failure"]
[null,null,"Pink cells require no data input - locked down"]
[null,null,"Blue cells require a calculation by the issuer"]

{"sheet":"Pt 2 Premium and Claims","index":3,"n_rows":76,"n_cols":48,"rows_kept":76,"cut":false,"hidden":false,"merged":[[14,45,15,45],[14,46,15,46],[16,1,17,3],[16,4,17,4],[5,5,5,6],[7,5,7,6],[11,5,11,6],[9,5,9,6],[15,39,15,43],[14,39,14,43],[7,8,7,9],[9,8,9,9],[11,8,11,9],[7,11,7,12],[9,11,9,12],[11,11,11,12],[75,3,75,4],[72,3,72,4],[5,11,5,12],[14,47,15,47],[15,5,15,9],[15,10,15,14],[15,15,15,19],[15,20,15,22],[15,23,15,25],[15,26,15,28],[14,5,14,19],[14,20,14,28],[14,29,14,38],[15,29,15,33],[15,34,15,38],[14,44,15,44]]}
[null,"Department of Health and Human Services"]
[null,"Medical Loss Ratio Reporting Form - Formula Tool"]
[null,"Part 2 - Premium and Claims"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,"Health Insurance Coverage",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Mini-Med Plans",null,null,null,null,null,null,null,null,"Expatriate Plans",null,null,null,null,null,null,null,null,null,"Student Health Plans",null,null,null,null,"Government Program Plans","Other Health Business","Aggregate 2% Rule","Uninsured Plans"]
[null,null,null,null,null,"Individual",null,null,null,null,"Small Group",null,null,null,null,"Large Group",null,null,null,null,"Individual",null,null,"Small Group",null,null,"Large Group",null,null,"Small Group",null,null,null,null,"Large Group",null,null,null,null,"Individual"]
[null,"Part 2\nNOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW.",null,null,"NAIC Supp. Health Care Exhibit Line","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 3/31/14","Dual Contract (Included in 3/31/14)","Deferred PY1 (Add)","Deferred CY (Subtract)","Total as of 12/31/13","Total as of 12/31/13","Total as of 12/31/13","Total as of 12/31/13"]
[null,null,null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]
[null,"1.","Premium:"]
[null,null,1.1000000000000001,"Direct premium written","Pt 2, Ln 1.1"]
[null,null,1.2,"Unearned premium prior year","Pt 2, Ln 1.2"]
[null,null,1.3,"Unearned premium MLR Reporting year","Pt 2, Ln 1.3"]
[null,null,1.4,"Experience rating refunds (rate credits) paid"]
[null,null,null,"1.4a Experience rating refunds, with all incurred dates, paid in the MLR reporting year","Pt 2, Ln 1.5"]
[null,null,null,"1.4b Experience rating refunds associated with premium earned only in the reporting year and paid through 3/31 of the following year"]
[null,null,1.5,"Reserve for experience rating refunds (rate credits) MLR Reporting year","Pt 2, Ln 1.6"]
[null,null,1.6,"Reserve for experience rating refunds (rate credits) prior year","Pt 2, Ln 1.7"]
[null,null,1.7,"Premium balances written off","Pt 2, Ln 1.9"]
[null,null,1.8,"Group conversion charges","Pt 2, Ln 1.10"]
[null,null,1.9,"Premium ceded under 100% reinsurance (informational only; excluded from Line 1.1)"]
[null,null,1.1000000000000001,"Premium assumed under 100% reinsurance (informational only; already included in Line 1.1)"]
[]
[null,"2.","Claims:"]
[null,null,2.1,"Claims Paid"]
[null,null,null,"2.1a  Claims paid during the MLR reporting year regardless of incurred date","Pt 2, Ln 2.1"]
[null,null,null,"2.1b  Claims incurred only during the MLR reporting year, paid through 3/31 of the following year"]
[null,null,2.2000000000000002,"Direct claim liability"]
[null,null,null,"2.2a Liability as of 12/31 of MLR reporting year for all claims regardless of incurred date","Pt 2, Ln 2.2"]
[null,null,null,"2.2b Liability for claims incurred only during the MLR reporting year, calculated as of 3/31 of the following year"]
[null,null,2.2999999999999998,"Direct claim liability prior year","Pt 2, Ln 2.3"]
[null,null,2.4,"Direct claim reserves"]
[null,null,null,"2.4a Reserves as of 12/31 of MLR reporting year for all claims regardless of incurred date","Pt 2, Ln 2.4"]
[null,null,null,"2.4b Reserves for claims incurred only during the MLR reporting year, calculated as of 3/31 of the following year"]
[null,null,2.5,"Direct claim reserves prior year","Pt 2, Ln 2.5"]
[null,null,2.6,"Direct contract reserves"]
[null,null,null,"2.6a Direct contract reserves 12/31 column","Pt 2, Ln 2.6"]
[null,null,null,"2.6b Direct contract reserves 3/31, dual contract, deferred columns"]
[null,null,2.7,"Direct contract reserves prior year","Pt 2, Ln 2.7"]
[null,null,2.8,"Experience rating refunds (rate credits) paid"]
[null,null,null,"2.8a Experience rating refunds, with all incurred dates, paid in the MLR reporting year","Pt 2, Ln 2.8"]
[null,null,null,"2.8b Experience rating refunds associated with premium earned only in the reporting year and paid through 3/31 of the following year"]
[null,null,2.9,"Reserve for experience rating refunds (rate credits)"]
[null,null,null,"2.9a Reserved in MLR reporting year regardless of incurred date","Pt 2, Ln 2.9"]
[null,null,null,"2.9b Reserves specific to the MLR reporting year through 3/31 of the following year"]
[null,null,"2.10","Reserve for experience rating refunds (rate credits) prior year","Pt 2, Ln 2.10"]
[null,null,2.11,"Incurred medical incentive pool and bonuses"]
[null,null,null,"2.11a  Paid medical incentive pools and bonuses MLR Reporting year","Pt 2, Ln 2.11a"]
[null,null,null,"2.11b  Accrued medical incentive pools and bonuses MLR Reporting year","Pt 2, Ln 2.11b"]
[null,null,null,"2.11c  Accrued medical incentive pools and bonuses prior year","Pt 2, Ln 2.11c"]
[null,null,2.12,"Net healthcare receivables "]
[null,null,null,"2.12a  Healthcare receivables MLR Reporting year","Pt 2, Ln 2.12a"]
[null,null,null,"2.12b  Healthcare receivables prior year","Pt 2, Ln 2.12b"]
[null,null,2.13,"Contingent benefit and lawsuit reserves"]
[null,null,2.14,"Group conversion charges","Pt 2, Ln 2.13"]
[null,null,2.15,"Blended rate adjustment","Pt 2, Ln 2.14"]
[null,null,2.16,"Total incurred claims ","Pt 2, Ln 2.15",{"$f":"F35+F38-F40+F42-F44+F46-F48+F50+F53-F55+F57+F58-F59-F61+F62+F63+F64+F65","v":0},{"$f":"G36+G39+G43+G47-G48+G51+G54+G57+G58-G61+G63+G64+G65","v":0},{"$f":"H36+H39+H43+H47-H48+H51+H54+H57+H58-H61+H63+H64+H65","v":0},0,0,{"$f":"K35+K38-K40+K42-K44+K46-K48+K50+K53-K55+K57+K58-K59-K61+K62+K63+K64+K65","v":0},{"$f":"L36+L39+L43+L47-L48+L51+L54+L57+L58-L61+L63+L64+L65","v":0},{"$f":"M36+M39+M43+M47-M48+M51+M54+M57+M58-M61+M63+M64+M65","v":0},0,0,{"$f":"P35+P38-P40+P42-P44+P46-P48+P50+P53-P55+P57+P58-P59-P61+P62+P63+P64+P65","v":0},{"$f":"Q36+Q39+Q43+Q47-Q48+Q51+Q54+Q57+Q58-Q61+Q63+Q64+Q65","v":0},{"$f":"R36+R39+R43+R47-R48+R51+R54+R57+R58-R61+R63+R64+R65","v":0},0,0,{"$f":"U35+U38-U40+U42-U44+U46-U48+U50+U53-U55+U57+U58-U59-U61+U62+U63+U64+U65","v":0},{"$f":"V36+V39+V43+V47-V48+V51+V54+V57+V58-V61+V63+V64+V65","v":0},{"$f":"W36+W39+W43+W47-W48+W51+W54+W57+W58-W61+W63+W64+W65","v":0},{"$f":"X35+X38-X40+X42-X44+X46-X48+X50+X53-X55+X57+X58-X59-X61+X62+X63+X64+X65","v":0},{"$f":"Y36+Y39+Y43+Y47-Y48+Y51+Y54+Y57+Y58-Y61+Y63+Y64+Y65","v":0},{"$f":"Z36+Z39+Z43+Z47-Z48+Z51+Z54+Z57+Z58-Z61+Z63+Z64+Z65","v":0},{"$f":"AA35+AA38-AA40+AA42-AA44+AA46-AA48+AA50+AA53-AA55+AA57+AA58-AA59-AA61+AA62+AA63+AA64+AA65","v":0},{"$f":"AB36+AB39+AB43+AB47-AB48+AB51+AB54+AB57+AB58-AB61+AB63+AB64+AB65","v":0},{"$f":"AC36+AC39+AC43+AC47-AC48+AC51+AC54+AC57+AC58-AC61+AC63+AC64+AC65","v":0},null,null,null,null,null,null,null,null,null,null,{"$f":"AN35+AN38-AN40+AN42-AN44+AN46-AN48+AN50+AN53-AN55+AN57+AN58-AN59-AN61+AN62+AN63+AN64+AN65","v":0},{"$f":"AO36+AO39+AO43+AO47-AO48+AO51+AO54+AO57+AO58-AO61+AO63+AO64+AO65","v":0},{"$f":"AP36+AP39+AP43+AP47-AP48+AP51+AP54+AP57+AP58-AP61+AP63+AP64+AP65","v":0},0,0,{"$f":"AS35+AS38-AS40+AS42-AS44+AS46-AS48+AS50+AS53-AS55+AS57+AS58-AS59-AS61+AS62+AS63+AS64+AS65","v":0},0,0]
[null,null,2.17,"Allowable fraud reduction expense (the smaller of Lines 2.17a or 2.17b)","Pt 1, Ln 4",{"$f":"MIN(MAX(0,F68),MAX(0,F69))","v":0},{"$f":"MIN(MAX(0,G68),MAX(0,G69))","v":0},{"$f":"MIN(MAX(0,H68),MAX(0,H69))","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,null,null,null,null,null,null,null,null,null,null,0,0,0,0,0,0,0,0]
[null,null,null,"2.17a  Total fraud reduction expense","Pt 3, Col 7, Ln 1.11/ 2.11/3.11/5.11/6.11"]
[null,null,null,"2.17b  Total fraud recoveries that reduced paid claims in Line 2.1","Pt 2, Ln 3"]
[]
[]
[null,null,"Cell Keys:"]
[null,null,null,"Blank cells require input from issuer"]
[null,null,null,"Grey cells require no data input – input will result in an upload failure"]
[null,null,null,"Pink cells require no data input - locked down"]
[null,null,null,"Blue cells require a calculation by the issuer"]

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[null,"Department of Health and Human Services"]
[null,"Medical Loss Ratio Reporting Form - Formula Tool",null,null,null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"Part 4 - MLR and Rebate Calculation",null,null,null,null,null,null,null,null,null,"Merge Markets - Ind/SmGrp (MA Only)"]
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[null,null,null,null,null,null,null,null,"Business in the State of:"]
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[null,null,null,null,null,null,null,null,null,null,null,"MLR Reporting Year:"]
[null,"",null,null,null,"",null,null,"",null,null,{"$f":"'Pt 1 Summary of Data'!$L$12","v":2013},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[]
[null,null,null,null,"Health Insurance Coverage",null,null,null,null,null,null,null,null,null,null,null,"Mini-Med Plans",null,null,null,null,null,null,null,null,null,null,null,"Expatriate Plans",null,null,null,null,null,null,null,"Student Health Plans"]
[null,null,null,null,"Individual",null,null,null,"Small Group",null,null,null,"Large Group",null,null,null,"Individual",null,null,null,"Small Group",null,null,null,"Large Group",null,null,null,"Small Group",null,null,null,"Large Group",null,null,null,"Individual"]
[null,"Part 4\nNOTE: REFER TO MLR INSTRUCTIONS, FORMULAS RESOURCE AND TABLES RESOURCE FOR IMPORTANT INFORMATION ABOUT COMPLETING EACH COLUMN AND ROW.",null,null,"PY2","PY1","CY","Total ","PY2","PY1","CY","Total","PY2","PY1","CY","Total","PY2","PY1","CY","Total ","PY2","PY1","CY","Total","PY2","PY1","CY","Total","PY2","PY1","CY","Total ","PY2","PY1","CY","Total","PY2","PY1","CY","Total "]
[null,null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]
[null,"1.","Medical Loss Ratio Numerator"]
[null,null,1.1000000000000001,"Adjusted incurred claims as reported on MLR Form for prior year(s)"]
[null,null,1.2,"Adjusted incurred claims as of 3/31 of the year following the MLR reporting year ",null,null,{"$f":"('Pt 2 Premium and Claims'!G$36+'Pt 2 Premium and Claims'!G$39+'Pt 2 Premium and Claims'!G$43+'Pt 2 Premium and Claims'!G$47-'Pt 2 Premium and Claims'!G$48+'Pt 2 Premium and Claims'!G$51+'Pt 2 Premium and Claims'!G$54+'Pt 2 Premium and Claims'!G$57+'Pt 2 Premium and Claims'!G$58-'Pt 2 Premium and Claims'!G$61+'Pt 2 Premium and Claims'!G$63+'Pt 2 Premium and Claims'!G$64+'Pt 2 Premium and Claims'!G$65+MIN(MAX(0,'Pt 2 Premium and Claims'!G$68),MAX(0,'Pt 2 Premium and Claims'!G$69)))+('Pt 2 Premium and Claims'!I$36+'Pt 2 Premium and Claims'!I$39+'Pt 2 Premium and Claims'!I$43+'Pt 2 Premium and Claims'!I$47-'Pt 2 Premium and Claims'!I$48+'Pt 2 Premium and Claims'!I$51+'Pt 2 Premium and Claims'!I$54+'Pt 2 Premium and Claims'!I$57+'Pt 2 Premium and Claims'!I$58-'Pt 2 Premium and Claims'!I$61+'Pt 2 Premium and Claims'!I$63+'Pt 2 Premium and Claims'!I$64+'Pt 2 Premium and 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Claims'!L$64+'Pt 2 Premium and Claims'!L$65+MIN(MAX(0,'Pt 2 Premium and Claims'!L$68),MAX(0,'Pt 2 Premium and Claims'!L$69)))+('Pt 2 Premium and Claims'!N$36+'Pt 2 Premium and Claims'!N$39+'Pt 2 Premium and Claims'!N$43+'Pt 2 Premium and Claims'!N$47-'Pt 2 Premium and Claims'!N$48+'Pt 2 Premium and Claims'!N$51+'Pt 2 Premium and Claims'!N$54+'Pt 2 Premium and Claims'!N$57+'Pt 2 Premium and Claims'!N$58-'Pt 2 Premium and Claims'!N$61+'Pt 2 Premium and Claims'!N$63+'Pt 2 Premium and Claims'!N$64+'Pt 2 Premium and Claims'!N$65+MIN(MAX(0,'Pt 2 Premium and Claims'!N$68),MAX(0,'Pt 2 Premium and Claims'!N$69)))-('Pt 2 Premium and Claims'!O$36+'Pt 2 Premium and Claims'!O$39+'Pt 2 Premium and Claims'!O$43+'Pt 2 Premium and Claims'!O$47-'Pt 2 Premium and Claims'!O$48+'Pt 2 Premium and Claims'!O$51+'Pt 2 Premium and Claims'!O$54+'Pt 2 Premium and Claims'!O$57+'Pt 2 Premium and Claims'!O$58-'Pt 2 Premium and Claims'!O$61+'Pt 2 Premium and Claims'!O$63+'Pt 2 Premium and Claims'!O$64+'Pt 2 Premium 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[null,null,1.3,"Improving Health Care Quality Expenses ",null,null,{"$f":"SUM('Pt 1 Summary of Data'!G$52:G$57)+SUM('Pt 1 Summary of Data'!I$52:I$57)-SUM('Pt 1 Summary of Data'!J$52:J$57)","v":0},{"$f":"SUM(E17:G17)","v":0},null,null,{"$f":"SUM('Pt 1 Summary of Data'!L$52:L$57)+SUM('Pt 1 Summary of Data'!N$52:N$57)-SUM('Pt 1 Summary of Data'!O$52:O$57)","v":0},{"$f":"SUM(I17:K17)","v":0},null,null,{"$f":"SUM('Pt 1 Summary of Data'!Q$52:Q$57)+SUM('Pt 1 Summary of Data'!S$52:S$57)-SUM('Pt 1 Summary of Data'!T$52:T$57)","v":0},{"$f":"SUM(M17:O17)","v":0},null,null,{"$f":"SUM('Pt 1 Summary of Data'!V$52:V$57)","v":0},{"$f":"SUM(Q17:S17)","v":0},null,null,{"$f":"SUM('Pt 1 Summary of Data'!Y$52:Y$57)","v":0},{"$f":"SUM(U17:W17)","v":0},null,null,{"$f":"SUM('Pt 1 Summary of Data'!AB$52:AB$57)","v":0},{"$f":"SUM(Y17:AA17)","v":0},null,null,null,null,null,null,null,null,null,null,{"$f":"SUM('Pt 1 Summary of Data'!AO$52:AO$57)+SUM('Pt 1 Summary of Data'!AQ$52:AQ$57)-SUM('Pt 1 Summary of Data'!AR$52:AR$57)","v":0},{"$f":"IF(AM$28<75000,AL17+AM17,AM17)","v":0}]
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[]
[null,"3.","Credibility Adjustment"]
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[null,null,3.3,"Average deductible "]
[null,null,3.4,"Deductible factor ",null,null,null,{"$f":"IF(H$30<2500,1,(MIN(VLOOKUP(H$30,Tables!$A$19:$B$22,2)+((H$30-VLOOKUP(H$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(H$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(H$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(H$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(H$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,{"$f":"IF(L$30<2500,1,(MIN(VLOOKUP(L$30,Tables!$A$19:$B$22,2)+((L$30-VLOOKUP(L$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(L$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(L$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(L$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(L$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,{"$f":"IF(P$30<2500,1,(MIN(VLOOKUP(P$30,Tables!$A$19:$B$22,2)+((P$30-VLOOKUP(P$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(P$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(P$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(P$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(P$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,{"$f":"IF(T$30<2500,1,(MIN(VLOOKUP(T$30,Tables!$A$19:$B$22,2)+((T$30-VLOOKUP(T$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(T$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(T$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(T$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(T$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,{"$f":"IF(X$30<2500,1,(MIN(VLOOKUP(X$30,Tables!$A$19:$B$22,2)+((X$30-VLOOKUP(X$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(X$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(X$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(X$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(X$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,{"$f":"IF(AB$30<2500,1,(MIN(VLOOKUP(AB$30,Tables!$A$19:$B$22,2)+((AB$30-VLOOKUP(AB$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(AB$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(AB$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(AB$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(AB$30,Tables!$A$19:$B$22,1))),1.736)))","v":1},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AN$30<2500,1,(MIN(VLOOKUP(AN$30,Tables!$A$19:$B$22,2)+((AN$30-VLOOKUP(AN$30,Tables!$A$19:$B$22,1))*(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(AN$30,Tables!$A$19:$A$22)),1,1)-VLOOKUP(AN$30,Tables!$A$19:$B$22,2))/(OFFSET(INDEX(Tables!$A$19:$A$22,MATCH(AN$30,Tables!$A$19:$A$22)),1,0)-VLOOKUP(AN$30,Tables!$A$19:$B$22,1))),1.736)))","v":1}]
[null,null,3.5,"Credibility adjustment (Lines 3.2 x 3.4 (do not round)) ",null,null,null,{"$f":"IF(OR(H$28<1000,H$28>=75000),0,H$29*H$31)","v":0},null,null,null,{"$f":"IF(OR(L$28<1000,L$28>=75000),0,L$29*L$31)","v":0},null,null,null,{"$f":"IF(OR(P$28<1000,P$28>=75000),0,P$29*P$31)","v":0},null,null,null,{"$f":"IF(OR(T$28<1000,T$28>=75000),0,T$29*T$31)","v":0},null,null,null,{"$f":"IF(OR(X$28<1000,X$28>=75000),0,X$29*X$31)","v":0},null,null,null,{"$f":"IF(OR(AB$28<1000,AB$28>=75000),0,AB$29*AB$31)","v":0},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(AN$28<1000,AN$28>=75000),0,AN$29*AN$31)","v":0}]
[]
[null,"4.","MLR Calculation (for issuers with at least 1,000 life years in the Total column of Line 3.1)"]
[null,null,4.0999999999999996,"Preliminary MLR"]
[null,null,null,"4.1a  Preliminary MLR (Lines 1.5 / 2.3)",{"$f":"IF(OR(E$28<1000,E$25<=0),\"\",E$19/E$25)","v":""},{"$f":"IF(OR(F$28<1000,F$25<=0),\"\",F$19/F$25)","v":""},"",{"$f":"IF(OR(H$28<1000,H$25=0),\"\",H$19/H$25)","v":""},"","","",{"$f":"IF(OR(L$28<1000,L$25=0),\"\",L$19/L$25)","v":""},"","","",{"$f":"IF(OR(P$28<1000,P$25=0),\"\",P$19/P$25)","v":""}]
[null,null,null,"4.1b  Preliminary MLR: Mini-Med and Student Health\n (Lines 1.6 / 2.3)",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(Q$28<1000,Q$25<=0),\"\",Q$20/Q$25)","v":""},{"$f":"IF(OR(R$28<1000,R$25<=0),\"\",R$20/R$25)","v":""},"",{"$f":"IF(OR(T$28<1000,T$25=0),\"\",T$20/T$25)","v":""},{"$f":"IF(OR(U$28<1000,U$25<=0),\"\",U$20/U$25)","v":""},"","",{"$f":"IF(OR(X$28<1000,X$25=0),\"\",X$20/X$25)","v":""},{"$f":"IF(OR(Y$28<1000,Y$25<=0),\"\",Y$20/Y$25)","v":""},{"$f":"IF(OR(Z$28<1000,Z$25<=0),\"\",Z$20/Z$25)","v":""},"",{"$f":"IF(OR(AB$28<1000,AB$25=0),\"\",AB$20/AB$25)","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(AN$28<1000,AN$25=0),\"\",AN$20/AN$25)","v":""}]
[null,null,4.2,"Credibility adjustment (Line 3.5, if applicable)",null,null,null,{"$f":"H$32","v":0},null,null,null,{"$f":"L$32","v":0},null,null,null,{"$f":"P$32","v":0},null,null,null,{"$f":"T$32","v":0},null,null,null,{"$f":"X$32","v":0},null,null,null,{"$f":"AB$32","v":0},null,null,null,null,null,null,null,null,null,null,null,{"$f":"AN$32","v":0}]
[null,null,4.3,"Credibility-adjusted MLR (Lines 4.1a or 4.1b + 4.2)",null,null,null,{"$f":"IF(H$36=\"\",\"\",ROUND(H$36+MAX(0,H$38),3))","v":""},null,null,null,{"$f":"IF(L$36=\"\",\"\",ROUND(L$36+MAX(0,L$38),3))","v":""},null,null,null,{"$f":"IF(P$36=\"\",\"\",ROUND(P$36+MAX(0,P$38),3))","v":""},null,null,null,{"$f":"IF(T$37=\"\",\"\",ROUND(T$37+MAX(0,T$38),3))","v":""},null,null,null,{"$f":"IF(X$37=\"\",\"\",ROUND(X$37+MAX(0,X$38),3))","v":""},null,null,null,{"$f":"IF(AB$37=\"\",\"\",ROUND(AB$37+MAX(0,AB$38),3))","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AN$37=\"\",\"\",ROUND(AN$37+MAX(0,AN$38),3))","v":""}]
[]
[null,"5.","Rebate Calculation"]
[null,null,5.0999999999999996,"MLR standard",null,null,null,{"$f":"G42","v":0},null,null,null,{"$f":"K42","v":0},null,null,null,{"$f":"O42","v":0},null,null,null,{"$f":"S42","v":0},null,null,null,{"$f":"W42","v":0},null,null,null,{"$f":"AA42","v":0}]
[null,null,5.2,"Credibility-adjusted MLR (Line 4.3)",null,null,null,{"$f":"H$39","v":""},null,null,null,{"$f":"L$39","v":""},null,null,null,{"$f":"P$39","v":""},null,null,null,{"$f":"T$39","v":""},null,null,null,{"$f":"X$39","v":""},null,null,null,{"$f":"AB$39","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"AN$39","v":""}]
[null,null,5.3,"Adjusted earned premium (Line 2.1 - 2.2 CY)",null,null,null,{"$f":"IF(H$28<1000,\"\",MAX(0,G$23-G$24))","v":""},null,null,null,{"$f":"IF(L$28<1000,\"\",MAX(0,K$23-K$24))","v":""},null,null,null,{"$f":"IF(P$28<1000,\"\",MAX(0,O$23-O$24))","v":""},null,null,null,{"$f":"IF(T$28<1000,\"\",MAX(0,S$23-S$24))","v":""},null,null,null,{"$f":"IF(X$28<1000,\"\",MAX(0,W$23-W$24))","v":""},null,null,null,{"$f":"IF(AB$28<1000,\"\",MAX(0,AA$23-AA$24))","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AN$28<1000,\"\",MAX(0,AM$23-AM$24))","v":""}]
[null,null,5.4,"Rebate amount if credibility-adjusted MLR is less than MLR standard (Lines (5.1 - 5.2) X 5.3)",null,null,null,{"$f":"IF(OR(H$28<1000,H$25<=0),0,MAX(0,H$42-H$43)*H$44)","v":0},null,null,null,{"$f":"IF(OR(L$28<1000,L$25<=0),0,MAX(0,L$42-L$43)*L$44)","v":0},null,null,null,{"$f":"IF(OR(P$28<1000,P$25<=0),0,MAX(0,P$42-P$43)*P$44)","v":0},null,null,null,{"$f":"IF(OR(T$28<1000,T$25<=0),0,MAX(0,T$42-T$43)*T$44)","v":0},null,null,null,{"$f":"IF(OR(X$28<1000,X$25<=0),0,MAX(0,X$42-X$43)*X$44)","v":0},null,null,null,{"$f":"IF(OR(AB$28<1000,AB$25<=0),0,MAX(0,AB$42-AB$43)*AB$44)","v":0},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(AN$28<1000,AN$25<=0),0,MAX(0,AN$42-AN$43)*AN$44)","v":0}]
[]
[null,"6.","Optional adjustments"]
[null,null,6.1,"ACA assessments on non-calendar year policies (2013 only)"]
[null,null,null,"6.1a  Deferred portion of 2013 premium collected for 2014 ACA \n         assessments or fees."]
[null,null,null,"6.1b  Total Federal and State taxes associated with the deferred premium \n         on Line 6.1a."]
[null,null,6.2,"Reserved for future use"]
[null,null,null,"6.2a  Reserved for future use"]
[null,null,null,"6.2b  Reserved for future use"]
[null,null,null,"6.2c  Reserved for future use"]
[null,null,null,"6.2d  Reserved for future use"]
[null,null,null,"6.2e  Reserved for future use"]
[null,null,null,"6.2f   Reserved for future use"]
[]
[]
[null,null,"Cell Keys:"]
[null,null,null,"Blank cells require input from issuer"]
[null,null,null,"Grey cells require no data input – input will result in an upload failure"]
[null,null,null,"Pink cells require no data input - locked down"]
[null,null,null,"Blue cells require a calculation by the issuer"]

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[]
[]
["Table 1",null,null,null,null,null,null,"Table 3",null,null,null,null,null,null,null,"Table 4",null,"Table 5"]
["Base Credibility Adjustment Factors",null,null,null,null,null,null,"State and Territory Names",null,null,null,null,null,null,null,"Reporting Years",null,"Yes/No"]
["Life Years","Base credibility factor",null,null,null,null,null,"Alabama",null,null,null,null,null,null,null,2011,null,"Yes"]
[0,0,null,null,null,null,null,"Alaska",null,null,null,null,null,null,null,2012,null,"No"]
[1000,8.3000000000000004E-2,null,null,null,null,null,"American Samoa",null,null,null,null,null,null,null,2013]
[2500,5.1999999999999998E-2,null,null,null,null,null,"Arizona",null,null,null,null,null,null,null,2014]
[5000,3.6999999999999998E-2,null,null,null,null,null,"Arkansas",null,null,null,null,null,null,null,2015]
[10000,2.5999999999999999E-2,null,null,null,null,null,"California",null,null,null,null,null,null,null,2016]
[25000,1.6E-2,null,null,null,null,null,"Canada",null,null,null,null,null,null,null,2017]
[50000,1.2E-2,null,null,null,null,null,"Colorado",null,null,null,null,null,null,null,2018]
[75000,0,null,null,null,null,null,"Connecticut",null,null,null,null,null,null,null,2019]
[null,null,null,null,null,null,null,"Delaware",null,null,null,null,null,null,null,2020]
[null,null,null,null,null,null,null,"District of Columbia",null,null,null,null,null,null,null,2021]
["Table 2",null,null,null,null,null,null,"Florida",null,null,null,null,null,null,null,2022]
["Deductible Factors",null,null,null,null,null,null,"Georgia",null,null,null,null,null,null,null,2023]
["Average Health Plan Deductible","Deductible factor",null,null,null,null,null,"Guam",null,null,null,null,null,null,null,2024]
[0,1,null,null,null,null,null,"Hawaii",null,null,null,null,null,null,null,2025]
[2500,1.1639999999999999,null,null,null,null,null,"Idaho",null,null,null,null,null,null,null,2026]
[5000,1.4019999999999999,null,null,null,null,null,"Illinois",null,null,null,null,null,null,null,2027]
[10000,1.736,null,null,null,null,null,"Indiana",null,null,null,null,null,null,null,2028]
[null,null,null,null,null,null,null,"Iowa",null,null,null,null,null,null,null,2029]
[null,null,null,null,null,null,null,"Kansas",null,null,null,null,null,null,null,2030]
[null,null,null,null,null,null,null,"Kentucky",null,null,null,null,null,null,null,2031]
[null,null,null,null,null,null,null,"Louisiana",null,null,null,null,null,null,null,2032]
[null,null,null,null,null,null,null,"Maine",null,null,null,null,null,null,null,2033]
[null,null,null,null,null,null,null,"Maryland",null,null,null,null,null,null,null,2034]
[null,null,null,null,null,null,null,"Massachusetts",null,null,null,null,null,null,null,2035]
[null,null,null,null,null,null,null,"Michigan",null,null,null,null,null,null,null,2036]
[null,null,null,null,null,null,null,"Minnesota",null,null,null,null,null,null,null,2037]
[null,null,null,null,null,null,null,"Mississippi",null,null,null,null,null,null,null,2038]
[null,null,null,null,null,null,null,"Missouri",null,null,null,null,null,null,null,2039]
[null,null,null,null,null,null,null,"Montana",null,null,null,null,null,null,null,2040]
[null,null,null,null,null,null,null,"MP",null,null,null,null,null,null,null,2041]
[null,null,null,null,null,null,null,"Nebraska",null,null,null,null,null,null,null,2042]
[null,null,null,null,null,null,null,"Nevada",null,null,null,null,null,null,null,2043]
[null,null,null,null,null,null,null,"New Hampshire",null,null,null,null,null,null,null,2044]
[null,null,null,null,null,null,null,"New Jersey",null,null,null,null,null,null,null,2045]
[null,null,null,null,null,null,null,"New Mexico",null,null,null,null,null,null,null,2046]
[null,null,null,null,null,null,null,"New York",null,null,null,null,null,null,null,2047]
[null,null,null,null,null,null,null,"North Carolina",null,null,null,null,null,null,null,2048]
[null,null,null,null,null,null,null,"North Dakota",null,null,null,null,null,null,null,2049]
[null,null,null,null,null,null,null,"Ohio",null,null,null,null,null,null,null,2050]
[null,null,null,null,null,null,null,"Oklahoma",null,null,null,null,null,null,null,2051]
[null,null,null,null,null,null,null,"Oregon",null,null,null,null,null,null,null,2052]
[null,null,null,null,null,null,null,"Other Territories",null,null,null,null,null,null,null,2053]
[null,null,null,null,null,null,null,"Pennsylvania",null,null,null,null,null,null,null,2054]
[null,null,null,null,null,null,null,"Puerto Rico",null,null,null,null,null,null,null,2055]
[null,null,null,null,null,null,null,"Rhode Island",null,null,null,null,null,null,null,2056]
[null,null,null,null,null,null,null,"South Carolina",null,null,null,null,null,null,null,2057]
[null,null,null,null,null,null,null,"South Dakota",null,null,null,null,null,null,null,2058]
[null,null,null,null,null,null,null,"Tennessee",null,null,null,null,null,null,null,2059]
[null,null,null,null,null,null,null,"Texas",null,null,null,null,null,null,null,2060]
[null,null,null,null,null,null,null,"Utah"]
[null,null,null,null,null,null,null,"Vermont"]
[null,null,null,null,null,null,null,"Virgin Islands"]
[null,null,null,null,null,null,null,"Virginia"]
[null,null,null,null,null,null,null,"Washington"]
[null,null,null,null,null,null,null,"West Virginia"]
[null,null,null,null,null,null,null,"Wisconsin"]
[null,null,null,null,null,null,null,"Wyoming"]
[null,null,null,null,null,null,null,"Grand Total"]