2024 -- S 2724 | |
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LC005462 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO INSURANCE -- NONPROFIT DENTAL SERVICE CORPORATIONS -- THE | |
RHODE ISLAND FAIR SHARE FOR DENTAL CARE ACT | |
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Introduced By: Senators Gallo, Felag, Cano, Lawson, and Pearson | |
Date Introduced: March 05, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. This act shall be known and may be cited as "The Rhode Island Fair Share |
2 | for Dental Care Act." |
3 | SECTION 2. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service |
4 | Corporations" is hereby amended by adding thereto the following section: |
5 | 27-20.1-23. Medical loss ratio requirements. |
6 | (a) Notwithstanding any general or special law to the contrary, the health insurance |
7 | commissioner (the "commissioner") shall require carriers offering dental benefit plans to annually |
8 | submit information as required by the commissioner, which shall include the current and projected |
9 | medical loss ratio for in-state claims, total claims for their plans and the components of projected |
10 | administrative expenses and financial information, including, but not limited to: |
11 | (1) Income, including, but not limited to, any and all sources; |
12 | (2) Underwriting, auditing, actuarial, financial analysis, treasury and investment expenses; |
13 | (3) Marketing and sales expenses, including, but not limited to, advertising, member |
14 | relations, member enrollment and all expenses associated with producers, brokers and benefit |
15 | consultants; and |
16 | (4) The annual report shall contain claims operations expenses, including, but not limited |
17 | to, adjudication, appeals, settlements and expenses associated with paying claims. Unless otherwise |
18 | determined by the commissioner, the following items shall be deemed to be an administrative cost |
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1 | expenditure for the purposes of calculating and reporting the medical loss ratio: |
2 | (i) Financial administration expenses; |
3 | (ii) Marketing and sales expenses; |
4 | (iii) Distribution expenses, including to its subsidiaries and affiliates; |
5 | (iv) Claims operations expenses; |
6 | (v) Medical administration expenses, such as disease management, care management, |
7 | utilization review and medical management activities; |
8 | (vi) Network operations expenses; |
9 | (vii) Charitable expenses; |
10 | (viii) Board, bureau or association fees; |
11 | (ix) State and federal tax expenses, including assessments; and |
12 | (x) Payroll expenses. |
13 | (b) If the annual medical loss ratio for in-state or total claims for their plans offered under |
14 | this section is less than the applicable percentage set forth in subsection (c) of this section, the |
15 | carrier shall refund the excess premium to its covered individuals and covered groups. A carrier |
16 | shall communicate within thirty (30) days to all individuals and groups that were covered under |
17 | plans during the relevant twelve (12) month period that such individuals and groups qualify for a |
18 | refund on the premium for the applicable twelve (12) month period or, if the individual or groups |
19 | are still covered by the carrier, a credit on the premium for the subsequent twelve (12) month period. |
20 | The total of all refunds issued shall equal the amount of a carrier’s earned premium that exceeds |
21 | that amount necessary to achieve a medical loss ratio of the applicable percentage set forth in |
22 | subsection (c) of this section, calculated using data reported by the carrier as prescribed under |
23 | regulations promulgated by the commissioner. The commissioner may authorize a waiver or |
24 | adjustment of this requirement only if it is determined that issuing refunds would result in financial |
25 | impairment for the carrier. |
26 | (c) The medical loss ratio set forth in subsection (b) of this section shall be eighty-five |
27 | percent (85%). |
28 | SECTION 3. This act shall take effect on January 1, 2025. |
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LC005462 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- NONPROFIT DENTAL SERVICE CORPORATIONS -- THE | |
RHODE ISLAND FAIR SHARE FOR DENTAL CARE ACT | |
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1 | This act would require carriers offering dental benefit plans to annually submit information |
2 | which includes the current and projected medical loss ratio for claims for their plans. The medical |
3 | loss ratio would be eighty-five percent (85%) for determining whether insureds are due a refund or |
4 | premium credit in any given year. |
5 | This act would take effect on January 1, 2025. |
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LC005462 | |
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