Premium Revenue. A Contractor must report to the Division the total Premium Revenue received from the Division for each MLR Reporting Year. Premium Revenue includes, but is not limited to, all monies paid by the Division to the Contractor for providing benefits and services as defined in the terms of the Contract and is inclusive of Capitation Payments, Capitation Premium Withhold amounts earned, Health Insurer Fee reimbursement, Risk Corridor adjustments, and any other Medicaid Managed Care Program Revenues, but is exclusive of any amounts received from DOM PBA. (Note: Other revenues may be inclusive of payments made for services such as high- cost drugs paid outside the capitation rate.)
Premium Revenue. Includes all capitation payments received from MDHHS plus additional cost settlement revenue less any lapse.
Premium Revenue. Includes the following for the MLR Reporting Year:
a. Capitation Payments, developed in accordance with 42 C.F.R. § 438.4, to the Contractor, for all Members under a risk contract approved under 42 C.F.R. § 438.3(a), excluding payments made under to 42 C.F.R. § 438.6(d).
b. State-developed one time payments, for specific life events of Members.
c. Other payments to the Contractor approved under 42 C.F.R. § 438.6(b)(3).
d. Unpaid cost-sharing amounts that the Contractor could have collected from Members under the contract, except those amounts the Contractor can show it made a reasonable, but unsuccessful, effort to collect.
e. All changes to unearned premium reserves.
f. Net payments or receipts related to risk sharing mechanisms developed in accordance with 42 C.F.R. §§ 438.5 or 438.6.
Premium Revenue. Premium revenue includes the following for the MLR reporting year:
a) Agency capitation payments, developed in accordance with 42 C.F.R. § 438.4, to the Contractor for all members under a risk contract approved under 42 C.F.R. § 438.3(a), excluding payments made under to 42 C.F.R. § 438.6(d).
b) Agency-developed one-time payments, for specific life events of members.
c) Other payments to the Contractor approved under 42 C.F.R. § 438.6(b)(3).
d) Unpaid cost-sharing amounts that the Contractor could have collected from members under the Contract, except those amounts the Contractor can show it made a reasonable, but unsuccessful, effort to collect.
e) All changes to unearned premium reserves.
f) Net payments or receipts related to risk sharing mechanisms developed in accordance with 42 C.F.R. § 438.5 or 42 C.F.R. § 438.6. D.4.11. Federal, State, and local taxes and licensing and regulatory fees. Taxes, licensing, and regulatory fees for the MLR reporting year include:
a) Statutory assessments to defray the operating expenses of any State or Federal department.
b) Examination fees in lieu of premium taxes as specified by State law.
c) Federal taxes and assessments allocated to Contractor, excluding Federal income taxes on investment income and capital gains and Federal employment taxes.
d) State and local taxes and assessments including:
Premium Revenue. Premium revenue is as defined in 42 CFR § 438.8 (f) (2).
Premium Revenue. Premium revenue includes the following for the MLR reporting year:
(i) State capitation payments, developed in accordance with § 438.4, to the MCO, PIHP, or PAHP for all enrollees under a risk contract approved under § 438.3(a), excluding payments made under § 438.6(d).
(ii) State‐developed one-time payments, for specific life events of enrollees.
(iii) Other payments to the MCO, PIHP, or PAHP approved under § 438.6(b)(3).
Premium Revenue. Premium revenue includes the following for the MLR reporting year:
Premium Revenue. (vi) Net payments or receipts related to risk sharing mechanisms developed in accordance with § 438.5 or § 438.6.
