Home/CFR/Title 45/Part 158
FEDERAL · 45 CFR

Part 158 — Issuer Use of Premium Revenue: Reporting and Rebate Requirements

66 sections · Title 45: Public Welfare

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