45 CFR Part 158
PART 158—ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS
- PART 158—ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS
- Subtitle A—Department of Health and Human Services › Subchapter B—Requirements Relating to Health Care Access
- § 158.101 Basis and scope.
- § 158.102 Applicability.
- § 158.103 Definitions.
- Subpart A—Disclosure and Reporting
- § 158.110 Reporting requirements related to premiums and expenditures.
- § 158.120 Aggregate reporting.
- § 158.121 Newer experience.
- § 158.130 Premium revenue.
- § 158.140 Reimbursement for clinical services provided to enrollees.
- § 158.150 Activities that improve health care quality.
- § 158.151 Expenditures related to Health Information Technology and meaningful use requirements.
- § 158.160 Other non-claims costs.
- § 158.161 Reporting of Federal and State licensing and regulatory fees.
- § 158.162 Reporting of Federal and State taxes.
- § 158.170 Allocation of expenses.
- Subpart B—Calculating and Providing the Rebate
- § 158.210 Minimum medical loss ratio.
- § 158.211 Requirement in States with a higher medical loss ratio.
- § 158.220 Aggregation of data in calculating an issuer's medical loss ratio.
- § 158.221 Formula for calculating an issuer's medical loss ratio.
- § 158.230 Credibility adjustment.
- § 158.231 Life-years used to determine credible experience.
- § 158.232 Calculating the credibility adjustment.
- § 158.240 Rebating premium if the applicable medical loss ratio standard is not met.
- § 158.241 Form of rebate.
- § 158.242 Recipients of rebates.
- § 158.243 De minimis rebates.
- § 158.244 Unclaimed rebates.
- § 158.250 Notice of rebates.
- § 158.251 Notice of MLR information.
- § 158.260 Reporting of rebates.
- § 158.270 Effect of rebate payments on solvency.
- Subpart C—Potential Adjustment to the MLR for a State's Individual Market
- § 158.301 Standard for adjustment to the medical loss ratio.
- § 158.310 Who may request adjustment to the medical loss ratio.
- § 158.311 Duration of adjustment to the medical loss ratio.
- § 158.320 Information supporting a request for adjustment to the medical loss ratio.
- § 158.321 Information regarding the State's individual health insurance market.
- § 158.322 Proposal for adjusted medical loss ratio.
- § 158.323 State contact information.
- § 158.330 Criteria for assessing request for adjustment to the medical loss ratio.
- § 158.340 Process for submitting request for adjustment to the medical loss ratio.
- § 158.341 Treatment as a public document.
- § 158.342 Invitation for public comments.
- § 158.343 Optional State hearing.
- § 158.344 Secretary's discretion to hold a hearing.
- § 158.345 Determination on a State's request for adjustment to the medical loss ratio.
- § 158.346 Request for reconsideration.
- § 158.350 Subsequent requests for adjustment to the medical loss ratio.
- Subpart D—HHS Enforcement
- § 158.401 HHS enforcement.
- § 158.402 Audits.
- § 158.403 Circumstances in which a State is conducting audits of issuers.
- Subpart E—Additional Requirements on Issuers
- § 158.501 Access to facilities and records.
- § 158.502 Maintenance of records.
- Subpart F—Federal Civil Penalties
- § 158.601 General rule regarding the imposition of civil penalties.
- § 158.602 Basis for imposing civil penalties.
- § 158.603 Notice to responsible entities.
- § 158.604 Request for extension.
- § 158.605 Responses to allegations of noncompliance.
- § 158.606 Amount of penalty—general.
- § 158.607 Factors HHS uses to determine the amount of penalty.
- § 158.608 Determining the amount of the penalty—mitigating circumstances.
- § 158.609 Determining the amount of penalty—aggravating circumstances.
- § 158.610 Determining the amount of penalty—other matters as justice may require.
- § 158.611 Settlement authority.
- § 158.612 Limitations on penalties.
- § 158.613 Notice of proposed penalty.
- § 158.614 Appeal of proposed penalty.
- § 158.615 Failure to request a hearing.
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