Title 27
Insurance

Chapter 82
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 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.