Common use of Medical Loss Ratio Clause in Contracts

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications: ▪ The MLR calculation shall be performed separately for each MLR reporting year. ▪ The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty-five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications:

Medical Loss Ratio. In calendar year 2017, the MLR shall be calculated as follows: On an annual basis the Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR), based on standards and forms established by the National Association of Insurance Commissioners (NAIC). A separate MLR shall be calculated for the Contractor’s Hoosier Healthwise line of business. The MLR calculations shall be exclusive of any taxes. In addition, the State provides the following clarifications: ▪  The MLR calculation shall be performed separately for each MLR reporting year. ▪  The MLR calculation shall be performed separately for each program. The MLR for the Hoosier Healthwise program shall be calculated separately from other managed care programs. The Contractor shall maintain, at minimum, a MLR of eighty-five percent (85%) for its Hoosier Healthwise line of business. The MLR will be calculated exclusive of reimbursement for the health insurance providers’ fee (see Section 2.6.7). The Contractor is required to submit MLR reporting as described in the MCE Reporting Manual for Hoosier Healthwise. FSSA shall recoup excess capitation paid to the Contractor in the event that the Contractor’s MLR, as calculated by FSSA on an annual basis, is less than eighty-eighty- five percent (85%) for the Hoosier Healthwise line of business. Beginning in calendar year 2018, the MLR shall be calculated as follows: The Contractor shall calculate and submit to FSSA its Medical Loss Ratio (MLR). The calculation must fully comply with 42 CFR 438.8. In addition, the State provides the following clarifications::  The MLR calculation shall be performed separately for each MLR reporting year.