MLR Examinations

Pursuant to the Secretary of the Department of Health and Human Service’s authority under 45 CFR 158, Subpart D, CCIIO regularly reviews issuers’ annual MLR Reporting Forms to confirm compliance with each reporting element of 45 CFR Part 158.  CCIIO performs two types of reviews: internal compliance reviews as well as external audits (or examinations) of issuers’ annual MLR Reporting Form(s) and, beginning with the 2014 reporting year, if applicable, their annual Plan-Level Risk Corridors Data Reporting Form.

Internal compliance reviews consist of a high-level review of, amongst other things, the Reporting Form for: completion accuracy; obvious omissions, errors or questionable data; and, comparison to each issuer’s state Supplemental Health Care Exhibit (SHCE).

External audits consist of substantively testing each reporting element utilizing the Agreed-Upon Procedures (AUP) that CCIIO created in conjunction with the National Association of Insurance Commissioners (NAIC), as well as a detailed review of the documents and data that were used by the issuer under review in the completion of the Reporting Form.  Document and data reviews are generally conducted remotely but on-site reviews occur as well.  Entrance, status and exit calls are conducted telephonically.

MLR Examination Reports

The MLR examination program commenced in 2015 with review of data reported for the 2013 MLR reporting year.  This page contains MLR examination reports that are organized by the MLR reporting year.  Reports will be uploaded as each examination is completed and the Report, including company responses, is finalized.

Examination Reports by MLR Reporting Year:

• 2013
  • American Alternative Insurance Corporation, Delaware (PDF)
  • Blue Cross Blue Shield of Alabama (PDF) (PDF – 255 KB)
  • Blue Cross Blue Shield of Arizona (PDF)
  • Blue Cross Blue Shield of Florida (PDF) (PDF – 197 KB)
  • Blue Cross Blue Shield of Massachusetts (PDF)
  • Blue Cross Blue Shield of Michigan Mutual Insurance Company, Michigan (PDF) (PDF – 183 KB)
  • Blue Cross Blue Shield of Minnesota (PDF)
  • Blue Cross Blue Shield of Wisconsin (PDF) (PDF – (179 KB)
  • Capital Health Plan, Florida (PDF) (PDF – 200 KB)
  • CareFirst BlueChoice, Inc., Washington, DC (PDF)
  • ConnectiCare of Massachusetts (PDF) (PDF – 195 KB)
  • Enterprise Life Insurance Company, Texas (PDF) (PDF – 192 KB)
  • Freedom Life Insurance Company of America, Texas (PDF)
  • Group Health Options, Inc., Washington (PDF)
  • Group Hospitalization and Medical Services, Inc., Washington, DC (PDF) 
  • Harvard Pilgrim Health Care, Inc., Massachusetts (PDF)
  • Hawaii Management Alliance Association (PDF)
  • HealthAmerica Pennsylvania (PDF) (PDF – 177 KB)
  • HealthAssurance Pennsylvania (PDF) (PDF – 175 KB)
  • Health Alliance Medical Plans, Inc., Illinois (PDF) 
  • Health First Health Plans, Florida (PDF) (PDF – 198 KB)
  • Horizon Healthcare Services, Inc., New Jersey (PDF)
  • Liberty Union Life Assurance Company, Michigan  (PDF)(PDF - 244 KB)
  • Standard Life and Accident Insurance Company, Texas (PDF) (PDF – 172 KB)
  • Time Insurance Company, Wisconsin (PDF) (PDF – 367 KB)
  • Trustmark Life Insurance Company, Illinois (PDF)
  • Unity Health Plans Insurance Corporation, Wisconsin (PDF) (PDF – 170 KB)
  • Wellmark, Inc., Iowa (PDF) (PDF – 165 KB)
• 2014 
  • Blue Cross Blue Shield of Kansas City, Missouri (PDF)
  • Blue Cross Blue Shield of Vermont (PDF)
  • Cigna HealthCare of Colorado (PDF)
  • Cigna Life and Health Insurance Company, Connecticut (PDF)
  • Connecticut General Life Insurance Company (PDF)
  • HealthCare Service Corporation, Illinois (PDF)
  • HMO Louisiana, Inc. (PDF)
  • Humana Health Insurance Company, Wisconsin (PDF)
  • Humana Health Plan, Kentucky (PDF)
  • John Alden Life Insurance Company, Wisconsin (PDF)
  • Presbyterian Health Plan, Inc., New Mexico (PDF)
  • UnitedHealthcare Insurance Company of the River Valley, Illinois (PDF)
  • UnitedHealthcare of Illinois (PDF)
• 2015
  • Sanford Health Plan, South Dakota (PDF)
• 2017
  • Alliant Health Plans, Inc., Georgia (PDF)
  • Celtic Insurance Company, Illinois (PDF)
  • Dean Health Plan, Inc., Wisconsin (PDF)
  • Humana Health Insurance Company of Florida, Inc.  (PDF)
  • Medica Insurance Company (Minnesota) (PDF)
  • Pacific Source Health Plans, Oregon (PDF)
  • Physicians Health Plan, Michigan (PDF)
• 2018 
  • Health First Commercial Plans, Inc., Florida (PDF)
  • HMO Colorado, Inc. dba HMO Nevada (PDF)
  • The United States Life Insurance Company in the City of New York (PDF)
• 2019
  • Blue Care Network of Michigan (PDF)
  • CHRISTUS Health Plan, Texas (PDF)