# 2012 6-MLRCalculator _2_

Document Sample

```					                      Medical Loss Ratio Rebate Check Calculator
Input values in blue fields                                                       Instructions

NOTE-1: Minimum MLR Rebates are issued by an insurance
Total Company Premium Cost               \$                -                           company's legal entity. Your insurer may offer more than one plan to
Total Rebate Check Amount                \$                -                           your organization. As a result you might receive multiple Rebate
checks. Please be sure to properly identify which employees are
Rebate Percentage                             #DIV/0!                                 covered by the Insurance company issuing the rebate. This calculator
requires specific employee assignment by insurance plan.
Total Employee Premium Paid              \$                -
Employee Rebate                               #DIV/0!                                 NOTE-2: All calculations and inputs are for calendar year 2011.
Employer Rebate                               #DIV/0!
NOTE-3: Cells highlighted in BLUE are entries to be completed by the
Employee                                  end-user. Green highlighted cells are predefined calculations.
Employee                      Portion of Employee Rebate Check Amount
Step-1. Enter the total amount your company paid in premiums in cell
Employee 1                               \$           -            #DIV/0!             and Employee contribution amounts for 2011.
Employee 2                               \$           -            #DIV/0!
Employee 3                               \$           -            #DIV/0!             Step-2. Enter the total amount of your rebate check in cell (B6), “Total
Employee 4                               \$           -            #DIV/0!             Rebate Check Amount”. IF you received multiple rebate checks, add
the checks together as they relate to the 'Total Company Premium
Employee 5                               \$           -            #DIV/0!             Cost' for that Insurance plan.
Employee 6                               \$           -            #DIV/0!
Employee 7                               \$           -            #DIV/0!             DO NOT COMBINE CHECKS FROM DIFFERENT HEALTH PLANS.
Employee 8                               \$           -            #DIV/0!
Employee 9                               \$           -            #DIV/0!             Once you’ve completed steps one and two, the light-green box in cell
(B8) labeled, “Rebate Percentage,” will populate automatically. This is
Employee 10                              \$           -            #DIV/0!
the percentage that will be used to generate your employee rebate
Employee 11                              \$           -            #DIV/0!             amounts.
Employee 12                              \$           -            #DIV/0!
Employee 13                              \$           -            #DIV/0!             Step-3. Enter your first employee identifier in (Row 14) highlighted in
Employee 14                              \$           -            #DIV/0!             the light-blue box, under the “Employee” column. This will replace the
Employee 15                              \$           -            #DIV/0!             text, “Employee 1.” This identifier represents a single employee in
your company. You may use their name, an ID number, or whatever is
Employee 16                              \$           -            #DIV/0!             easiest for you. You may even choose to keep the label, “Employee 1.”
Employee 17                              \$           -            #DIV/0!             Please include only employees that makeup the Total Company
Employee 18                              \$           -            #DIV/0!             Premiums Paid (i.e. Full Time, Part Time, COBRA, early retiree, etc...)
Employee 19                              \$           -            #DIV/0!
Employee 20                              \$           -            #DIV/0!             Step-4. In the column labeled, “Employee Portion of Premium Paid,”
beside the employee ID you just entered, input the total amount that
Employee 21                              \$           -            #DIV/0!
employee paid in premiums. (Note: this number should not include
Employee 22                              \$           -            #DIV/0!             any portion of the premium you paid on behalf of the employee. Only
Employee 23                              \$           -            #DIV/0!             what came out of their own pay.)
Employee 24                              \$           -            #DIV/0!
Employee 25                              \$           -            #DIV/0!             After completing Step-3 & Step-4, the following cells high-lighted in
Employee 26                              \$           -            #DIV/0!             green will populate automatically:
Employee 27                              \$           -            #DIV/0!             the employees for that specific health insurance plan.
Employee 28                              \$           -            #DIV/0!             (B10) "Employee Rebate" total of the Employee rebate amount.
Employee 29                              \$           -            #DIV/0!             (B11) "Employer Rebate" total of the Employer rebate amount.
Employee 30                              \$           -            #DIV/0!
Employee 31                              \$           -            #DIV/0!             Legal disclaimer: This Medical Loss Ratio Rebate Calculator is provided
as a courtesy to our customers. We make no representation as to the
Employee 32                              \$           -            #DIV/0!
accuracy of the computation.
Employee 33                              \$           -            #DIV/0!
Employee 34                              \$           -            #DIV/0!
Employee 35                              \$           -            #DIV/0!
Employee 36                              \$           -            #DIV/0!
Employee 37                              \$           -            #DIV/0!
Employee 38                              \$           -            #DIV/0!
Employee 39                              \$           -            #DIV/0!
Employee 40                              \$           -            #DIV/0!
Employee 41                              \$           -            #DIV/0!
Employee 42                              \$           -            #DIV/0!
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Employee 99   \$   -   #DIV/0!
Employee 100   \$   -   #DIV/0!

```
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