The report filed by a group purchaser must meet the
requirements of items A to G. The information for each item must pertain to
health and medical related coverages, excluding accidental death and
dismemberment coverages, short-term disability coverages, long-term disability
coverages, long-term care coverages, workers' compensation coverages, the
medical component of automobile insurance coverages, and personal accident
coverages.
A. The report must include
total premium revenue and other revenue. "Other revenue" means, and must be
specifically itemized into, the categories of minimum premium plan revenue,
administrative services fee revenue, utilization review fee revenue,
reinsurance assumed revenue, and patient services revenue. Each revenue
category must separate commercial, Medicare, Medicare supplement, and other
public programs amounts.
B. The
report must include total expenses incurred by type of policy, including
commercial, self-insured, Medicare, Medicare supplement, and other public
programs. The report must separately list member liability for each policy
category.
C. The report must
include total expenses incurred by service category, including physician
services, other health professional services, inpatient hospital services,
outpatient services, skilled nursing facilities, home health care, emergency
services, pharmacy and other nondurable medical goods, durable medical goods,
chemical dependency services and mental health services, dental services, and
total indirect health care expenses. Each service category must be itemized by
type of policy as specified in item B. For coverages designed solely to provide
payments on a per diem, fixed indemnity, or non-expense-incurred basis, the
report may list total expenses rather than itemizing the expenses for these
coverages by service category.
D.
The report must include total member liability, or its actuarial estimate, for
all covered persons.
E. The report
must include total indirect health care expenses by the following categories:
billing and enrollment; claim processing; customer service; product management
and marketing; regulatory compliance and government relations; provider
relations and contracting; quality assurance and utilization management;
wellness and health education; research and product development; charitable
contributions; general administration; MinnesotaCare taxes; and all other taxes
and assessments. The information required for this report may be estimated from
existing accounting methods with allocation to specific categories.
F. The report must include the total number
of members and subscribers, as of the end of the reporting period, by type of
policy, including family policies and individual policies and member months for
the reporting period. Member months must be totaled for the calendar year of
the report. This information must be reported separately for medical and dental
contracts. Each category must be itemized by commercial, self-insured,
Medicare, Medicare supplement, and other public programs. Group purchasers that
do not maintain member information may submit actuarial estimates of total
number of members covered under all health policies.
G. The report must include a statement that
the revenue and expense amounts reported under items A and B reconcile to
audited financial statements. A group purchaser that does more than 80 percent
of its business in Minnesota shall reference the appropriate entries from its
audited financial statements and shall do so either by using the audited
financial statements for its entire health care business or by separating its
experience for Minnesota residents. The group purchaser's choice of method must
be consistent from year to year. A group purchaser that does 80 percent or less
of its business in Minnesota shall have an actuary or financial officer certify
that the amounts reported reconcile to the audited financial statement in a
manner consistent with prior reporting years and shall include an accounting or
actuarial memorandum describing the methods used to identify and separate
Minnesota data.