law24226

Chapter 226

2024 -- H 7944 SUBSTITUTE A
Enacted 06/24/2024

A N A C T

RELATING TO INSURANCE -- DENTAL INSURANCE LOSS RATIO REPORTING AND STUDY ACT

Introduced By: Representative Brandon T. Voas

Date Introduced: March 05, 2024

It is enacted by the General Assembly as follows:

SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by

adding thereto the following chapter:

CHAPTER 82

DENTAL INSURANCE LOSS RATIO REPORTING AND STUDY ACT

27-82-1. Short title.

This chapter shall be known and may be cited as the "Dental Insurance Loss Ratio

Reporting and Study Act."

27-82-2. Definitions.

As used in this chapter, the following terms shall mean:

(1) "Commissioner" or "health insurance commissioner" shall have the meaning set forth

in § 27-18-1.1.

(2) "Dental health insurance carrier" means a health insurance carrier, as defined in § 27-

18-1.1, to the extent that it provides insured dental services benefits coverage, including any entity

providing individual or group coverage for dental or oral surgery services or procedures:

(i) Through an individual or group policy of health, accident, and sickness insurance under

this title;

(ii) As a nonprofit hospital service corporation organized under chapter 19 of this title;

(iii) As a nonprofit medical service corporation organized under chapter 20 of this title;

(iv) As a nonprofit dental service corporation organized under chapter 20.1 of this title;

and/or

(v) As a health maintenance organization organized under chapter 41 of this title.

(3) “Dental loss ratio” (DLR) means the percentage of dental premium dollars spent on

patient care, calculated as follows:

(i) The numerator in the DLR is the incurred claims as defined in this section; and

(ii) The denominator in the DLR is the earned premiums as defined in this section.

(4) "Earned premiums" means, for any reporting year, the premium received up to the loss

measurement ratio date for coverage provided during the reporting year minus federal and state

taxes and assessments, and pass through payments made by the dental health insurance carrier as a

billing convenience for commissions or fees charged by a broker or consultant retained by the group

or individual receiving coverage, and for which the group or individual, as opposed to the dental

health insurance carrier, is responsible for payment.

(5) "Health insurance carrier" shall have the same meaning set forth in § 27-18-1.1.

(6) "Incurred claims" means, for a reporting year, the claims for which services were

provided in the reporting year, including an estimate of unpaid claim reserves and incurred value-

based care incentive pool and bonuses, the costs related to improving health care healthcare quality

and access, fraud reduction, charitable contributions made to nonprofit entities to improve access

to dental care to the disadvantaged and underserved populations; to encourage and support

workforce development as it relates to all components of dental care delivery including dentists,

hygienists, and assistants, and costs incurred for dental care management, including utilization

review.

(7) "Reporting year" means a calendar year during which group or individual dental

coverage is provided by a policy, contract, or certificate covering dental services.

27-82-3. Reporting.

Notwithstanding any provision of the general laws to the contrary, dental health insurance

carriers shall, on or before March 1, 2025, for reporting years 2023 and 2024, and on or before

March 1, 2026, for reporting year 2025, (the "transition period"), file with the commissioner, in a

format prescribed by the commissioner, an actuarial memorandum disclosing its incurred claims

and earned premiums for the preceding calendar reporting year, together with such additional

information as may be provided for in regulations promulgated by the commissioncommissioner

in accordance with this chapter.

27-82-4. Exemptions.

The reporting required by this chapter shall not apply to dental insurance plans issued,

delivered, or renewed to a self-insured group or where the carrier is acting as a third-party

administrator.

27-82-5. Regulations.

The commissioner shall, by January 1, 2025, promulgate rules and regulations as are

necessary to carry out and effectuate the provisions of this chapter.

27-82-6. Study report.

(a) On or before October 1, 2026, the commissioner shall provide the general assembly

with an analysis of the reporting information furnished pursuant to § 27-82-427-82-3, and

recommendations with respect to a minimum dental loss ratio. The report shall also include

recommendations with respect to requiring dental health carriers to offer a full range of

comprehensive dental benefit plans, including, but not limited to, one hundred percent (100%)

coverage options.

(b) The commissioner shall make a special annual assessment against each dental health

insurance carrier during years 2023, 2024, and 2025 for payment of all reasonable costs and

expenditures in connection with the study report and related analysis required by this section, no

greater than the combined maximum total of one hundred fifty thousand dollars ($150,000) per

year for all carriers. Each annual assessment shall, subject to the foregoing maximum, be deemed

as reasonably sufficient reimbursement for any costs and expenditures necessary for the

commissioner to fulfill the commissioners commissioner’s obligations under this section. The

sums shall be proportionately assessed by the commissioner against each dental health insurance

carrier based on relative annual fully insured membership enrollment, and may be billed whether

or not the study report has been completed. The carriers billed for such costs and expenditures shall

make payment to the commissioner within sixty (60) days of the date invoiced. Assessments made

pursuant to this section may be credited to the normal operating costs of each dental health

insurance carrier, and shall be deposited as general revenue.

SECTION 2. This act shall take effect upon passage.

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LC005079/SUB A

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