211 CMR, § 149.04
For purposes of 211 CMR 149.00, the following words shall mean:
Accumulated Surplus: Unassigned Funds (Surplus), defined as the undistributed and unappropriated amounts of surplus, in Statement ofStatutory Accounting Principle No. 72 of the NAIC Accounting Practices and Procedure Manual of March 2011.
Carrier: An insurer licensed or otherwise authorized to transact accident or health insurance under M.G.L. c. 175; a nonprofit hospital service corporation organized under M.G.L. c. 176A; a nonprofit medical service corporation organized under M.G.L. c. 176B; a health maintenance organization organized under M.G.L. c. 176G; and an organization entering into a preferred provider arrangement under M.G.L. c. 176I; but not including an employer purchasing coverage or acting on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer. Unless otherwise noted, the term Carrier shall not include any entity to the extent it offers a policy, certificate or contract that provides coverage solely for dental care services or vision care services. The term Carrier also shall not include any entity to the extent it offers a policy, certificate or contract that does not qualify as creditable coverage as defined in M.G.L. c. 111M, § 1.
Commissioner: The Commissioner of Insurance appointed pursuant to M.G.L. c. 26, § 6.
Commonwealth: The Commonwealth of Massachusetts.
Direct Claims Incurred: Paid claims during the year, plus net change in the direct claim liability, plus the change in direct claim reserves, plus the change in direct contract reserves, plus incurred medical incentive pools, plus change in net healthcare receivables and net reinsurance recoverables, as calculated in the Supplemental Health Care Exhibit as adopted by the NAIC on August 17, 2010.
Direct Premium Earned: Direct written premium plus the change in unearned premium reserves and the change in reserve for rate credits, minus the Regulatory authority licenses and fees, less write-offs, as calculated in the Supplemental Health Care Exhibit as adopted by the NAIC on August 17, 2010.
Division: The Massachusetts Division of Insurance established pursuant to M.G.L. c. 26, § 1.
Medical Loss Ratio (MLR): The ratio of the incurred loss (or Incurred Claims) plus the loss adjustment expense (or change in contract reserves) to earned premiums, according to current NAIC methodology, or as otherwise determined by the Commissioner. The MLR shall be calculated and submitted to the Division pursuant to St. 2010, c. 288 and 211 CMR 147.00.
NAIC: The National Association of Insurance Commissioners.
211 CMR, § 149.04