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Code of Federal Regulations (Last Updated: April 5, 2024) |
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Title 45 - Public Welfare |
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Subtitle A - Department of Health and Human Services |
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SubChapter B - Requirements Relating to Health Care Access |
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Part 158 - Issuer Use of Premium Revenue: Reporting and Rebate Requirements |
| § 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. |