MLR annual report

Cal. INS § 10112.26

California Statutes

(

a) A health insurer that issues, sells, renews, or offers a policy covering dental services shall file a report with the department, by July of each year, which shall be known as the MLR annual report. The MLR annual report shall be organized by market and product type and contains the same information required in the federal Medical Loss Ratio (MLR) Annual Reporting Form (CMS-10418). The department shall post a health insurer’s MLR annual report on its Internet Web site within days after receiving the report. (

b) The MLR reporting year shall be for the calendar year during which dental coverage is provided by the plan. As applicable, all terms used in the MLR annual report shall have the same meaning as used in the federal Public Health Service Act (42 U.S.C.

Sec. 300gg-18) and

Part 158 (commencing with

Section 158.101) of Title of the Code of Federal Regulations. (

c) If the commissioner decides to conduct an examination, as described in

Section 730, because the commissioner finds it necessary to verify the health insurer’s representations in the MLR annual report, the department shall provide the health insurer with a notification days before the commencement of the examination. (

d) The health insurer shall have days from the date of notification to electronically submit to the department all requested records, books, and papers specified in subdivision (

a) of

Section 733. The commissioner may extend the time for a health insurer to comply with this subdivision upon a finding of good cause. (

e) The department shall make available to the public all of the data provided to the department pursuant to this section. (

f) This

section does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided in the Medi-Cal program (Chapter 7 (commencing with

Section 14000) and

Chapter 8 (commencing with

Section 14200) of Part of Division of the Welfare and Institutions Code), the Medi-Cal Access Program (Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code), or the California Major Risk Medical Insurance Program (Chapter 4 (commencing with

Section 15870) of

Part 3.3 of Division of the Welfare and Institutions Code), to the extent consistent with the federal Patient Protection and Affordable Care Act (Public Law 111-148). (

g) This

section does not apply to disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment only basis. (

h) The department may issue guidance to health insurers of specialized health insurance policies subject to this

section regarding compliance with this section. The guidance shall not be subject to the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code), and shall be effective only until the department adopts regulations pursuant to that act. The department shall consult with the Department of Managed Health Care in issuing the guidance specified in this section.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10112.26
Date2019-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10112.26.20189334

MLR annual report

Cal. INS § 10112.26

California Statutes

MLR annual report

Cal. INS § 10112.26

California Statutes

(

a) A health insurer that issues, sells, renews, or offers a policy covering dental services shall file a report with the department, by July of each year, which shall be known as the MLR annual report. The MLR annual report shall be organized by market and product type and contains the same information required in the federal Medical Loss Ratio (MLR) Annual Reporting Form (CMS-10418). The department shall post a health insurer’s MLR annual report on its Internet Web site within days after receiving the report. (

b) The MLR reporting year shall be for the calendar year during which dental coverage is provided by the plan. As applicable, all terms used in the MLR annual report shall have the same meaning as used in the federal Public Health Service Act (42 U.S.C.

Sec. 300gg-18) and

Part 158 (commencing with

Section 158.101) of Title of the Code of Federal Regulations. (

c) If the commissioner decides to conduct an examination, as described in

Section 730, because the commissioner finds it necessary to verify the health insurer’s representations in the MLR annual report, the department shall provide the health insurer with a notification days before the commencement of the examination. (

d) The health insurer shall have days from the date of notification to electronically submit to the department all requested records, books, and papers specified in subdivision (

a) of

Section 733. The commissioner may extend the time for a health insurer to comply with this subdivision upon a finding of good cause. (

e) The department shall make available to the public all of the data provided to the department pursuant to this section. (

f) This

section does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided in the Medi-Cal program (Chapter 7 (commencing with

Section 14000) and

Chapter 8 (commencing with

Section 14200) of Part of Division of the Welfare and Institutions Code), the Medi-Cal Access Program (Chapter 2 (commencing with

Section 15810) of

Part 3.3 of Division of the Welfare and Institutions Code), or the California Major Risk Medical Insurance Program (Chapter 4 (commencing with

Section 15870) of

Part 3.3 of Division of the Welfare and Institutions Code), to the extent consistent with the federal Patient Protection and Affordable Care Act (Public Law 111-148). (

g) This

section does not apply to disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment only basis. (

h) The department may issue guidance to health insurers of specialized health insurance policies subject to this

section regarding compliance with this section. The guidance shall not be subject to the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code), and shall be effective only until the department adopts regulations pursuant to that act. The department shall consult with the Department of Managed Health Care in issuing the guidance specified in this section.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10112.26
Date2019-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10112.26.20189334