Common use of Medical Loss Ratio Clause in Contracts

Medical Loss Ratio. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR submission must fully comply with 42 CFR 438.8(d)-(n) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the EXHIBIT 1.A SCOPE OF WORK basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:

Medical Loss Ratio. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the t he Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR submission calculation must fully comply with 42 CFR 438.8(d)-(n438.8(d)-(f) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the EXHIBIT 1.A SCOPE OF WORK basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:: ▪ The MLR calculation shall be performed separately for each MLR reporting year per 42 CFR 438.8(a). EXHIBIT 1

Medical Loss Ratio. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR submission calculation must fully comply with 42 CFR 438.8(d)-(n438.8(d)-(f) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the EXHIBIT 1.A SCOPE OF WORK basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:: EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN

Medical Loss Ratio. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR submission must fully comply with 42 CFR 438.8(d)-(n) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the EXHIBIT 1.A SCOPE OF WORK EXHIBIT basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications:

Medical Loss Ratio. The MLR shall be calculated as follows: Each reporting year, consistent with MLR standards as required in 42 CFR 438.8, the Contractor shall calculate, attest to the accuracy, and submit to FSSA its Medical Loss Ratio (MLR). For the HIP line of business, POWER Account expenditures may be included in both the numerator and denominator of the MLR calculation. The MLR submission calculation must fully comply with 42 CFR 438.8(d)-(n438.8(d)-(f) which specifies that the MLR calculation is the ratio of the numerator (as defined in accordance with 42 CFR 438.8(e)) to the denominator (as defined in accordance with 42 CFR 438.8(f)). In accordance with 42 CFR 438.604(a)(3), 42 CFR 438.606, and 42 CFR 438.8, the Contractor is required to submit data on the EXHIBIT 1.A SCOPE OF WORK basis of which the State determines the compliance with MLR requirements. In addition, the State provides the following clarifications: