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

     

     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:

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     SECTION 1. This act shall be known and may be cited as "The Rhode Island Fair Share

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for Dental Care Act."

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     SECTION 2. Chapter 27-20.1 of the General Laws entitled "Nonprofit Dental Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20.1-23. Medical loss ratio requirements.

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     (a) Notwithstanding any general or special law to the contrary, the health insurance

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commissioner (the "commissioner") shall require carriers offering dental benefit plans to annually

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submit information as required by the commissioner, which shall include the current and projected

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medical loss ratio for in-state claims, total claims for their plans and the components of projected

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administrative expenses and financial information, including, but not limited to:

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     (1) Income, including, but not limited to, any and all sources;

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     (2) Underwriting, auditing, actuarial, financial analysis, treasury and investment expenses;

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     (3) Marketing and sales expenses, including, but not limited to, advertising, member

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relations, member enrollment and all expenses associated with producers, brokers and benefit

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consultants; and

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     (4) The annual report shall contain claims operations expenses, including, but not limited

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to, adjudication, appeals, settlements and expenses associated with paying claims. Unless otherwise

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determined by the commissioner, the following items shall be deemed to be an administrative cost

 

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expenditure for the purposes of calculating and reporting the medical loss ratio:

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     (i) Financial administration expenses;

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     (ii) Marketing and sales expenses;

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     (iii) Distribution expenses, including to its subsidiaries and affiliates;

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     (iv) Claims operations expenses;

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     (v) Medical administration expenses, such as disease management, care management,

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utilization review and medical management activities;

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     (vi) Network operations expenses;

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     (vii) Charitable expenses;

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     (viii) Board, bureau or association fees;

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     (ix) State and federal tax expenses, including assessments; and

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     (x) Payroll expenses.

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     (b) If the annual medical loss ratio for in-state or total claims for their plans offered under

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this section is less than the applicable percentage set forth in subsection (c) of this section, the

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carrier shall refund the excess premium to its covered individuals and covered groups. A carrier

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shall communicate within thirty (30) days to all individuals and groups that were covered under

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plans during the relevant twelve (12) month period that such individuals and groups qualify for a

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refund on the premium for the applicable twelve (12) month period or, if the individual or groups

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are still covered by the carrier, a credit on the premium for the subsequent twelve (12) month period.

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The total of all refunds issued shall equal the amount of a carrier’s earned premium that exceeds

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that amount necessary to achieve a medical loss ratio of the applicable percentage set forth in

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subsection (c) of this section, calculated using data reported by the carrier as prescribed under

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regulations promulgated by the commissioner. The commissioner may authorize a waiver or

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adjustment of this requirement only if it is determined that issuing refunds would result in financial

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impairment for the carrier.

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     (c) The medical loss ratio set forth in subsection (b) of this section shall be eighty-five

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percent (85%).

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     SECTION 3. This act shall take effect on January 1, 2025.

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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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     This act would require carriers offering dental benefit plans to annually submit information

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which includes the current and projected medical loss ratio for claims for their plans. The medical

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loss ratio would be eighty-five percent (85%) for determining whether insureds are due a refund or

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premium credit in any given year.

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     This act would take effect on January 1, 2025.

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