2024 -- S 2873 SUBSTITUTE A | |
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LC005635/SUB A | |
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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 -- DENTAL INSURANCE LOSS RATIO REPORTING AND | |
STUDY ACT | |
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Introduced By: Senator Matthew L. LaMountain | |
Date Introduced: March 22, 2024 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by |
2 | adding thereto the following chapter: |
3 | CHAPTER 82 |
4 | DENTAL INSURANCE LOSS RATIO REPORTING AND STUDY ACT |
5 | 27-82-1. Short title. |
6 | This chapter shall be known and may be cited as the "Dental Insurance Loss Ratio |
7 | Reporting and Study Act." |
8 | 27-82-2. Definitions. |
9 | As used in this chapter, the following terms shall mean: |
10 | (1) "Commissioner" or "health insurance commissioner" shall have the meaning set forth |
11 | in § 27-18-1.1. |
12 | (2) "Dental health insurance carrier" means a health insurance carrier, as defined in § 27- |
13 | 18-1.1, to the extent that it provides insured dental services benefits coverage, including any entity |
14 | providing individual or group coverage for dental or oral surgery services or procedures: |
15 | (i) Through an individual or group policy of health, accident and sickness insurance under |
16 | this title; |
17 | (ii) As a nonprofit hospital service corporation organized under chapter 19 of this title; |
18 | (iii) As a nonprofit medical service corporation organized under chapter 20 of this title; |
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1 | (iv) As a nonprofit dental service corporation organized under chapter 20.1 of this title; |
2 | and/or |
3 | (v) As a health maintenance organization organized under chapter 41 of this title. |
4 | (3) “Dental loss ratio” (DLR) means the percentage of dental premium dollars spent on |
5 | patient care, calculated as follows: |
6 | (i) The numerator in the DLR is the incurred claims as defined in this section; and |
7 | (ii) The denominator in the DLR is the earned premiums as defined in this section. |
8 | (4) "Earned premiums" means, for any reporting year, the premium received up to the loss |
9 | measurement ratio date for coverage provided during the reporting year minus federal and state |
10 | taxes and assessments, and pass through payments made by the dental health insurance carrier as a |
11 | billing convenience for commissions or fees charged by a broker or consultant retained by the group |
12 | or individual receiving coverage, and for which the group or individual, as opposed to the dental |
13 | health insurance carrier, is responsible for payment. |
14 | (5) "Health insurance carrier" shall have the same meaning set forth in § 27-18-1.1. |
15 | (6) "Incurred claims" means, for a reporting year, the claims for which services were |
16 | provided in the reporting year, including an estimate of unpaid claim reserves and incurred value |
17 | based care incentive pool and bonuses, the costs related to improving health care quality and access, |
18 | fraud reduction, charitable contributions made to nonprofit entities to improve access to dental care |
19 | to the disadvantaged and underserved populations; to encourage and support workforce |
20 | development as it relates to all components of dental care delivery including dentists, hygienists |
21 | and assistants, and costs incurred for dental care management, including utilization review. |
22 | (7) "Reporting year" means a calendar year during which group or individual dental |
23 | coverage is provided by a policy, contract, or certificate covering dental services. |
24 | 27-82-3. Reporting. |
25 | Notwithstanding any provision of the general laws to the contrary, dental health insurance |
26 | carriers shall, on or before March 1, 2025 for reporting years 2023 and 2024, and on or before |
27 | March 1, 2026 for reporting year 2025, (the "transition period"), file with the commissioner, in a |
28 | format prescribed by the commissioner, an actuarial memorandum disclosing its incurred claims |
29 | and earned premiums for the preceding calendar reporting year, together with such additional |
30 | information as may be provided for in regulations promulgated by the commission in accordance |
31 | with this chapter. |
32 | 27-82-4. Exemptions. |
33 | The reporting required by this chapter shall not apply to dental insurance plans issued, |
34 | delivered or renewed to a self-insured group or where the carrier is acting as a third-party |
| LC005635/SUB A - Page 2 of 3 |
1 | administrator. |
2 | 27-82-5. Regulations. |
3 | The commissioner shall, by January 1, 2025, promulgate rules and regulations as are |
4 | necessary to carry out and effectuate the provisions of this chapter. |
5 | 27-82-6. Study report. |
6 | (a) On or before October 1, 2026, the commissioner shall provide the general assembly |
7 | with an analysis of the reporting information furnished pursuant to § 27-82-4, and |
8 | recommendations with respect to a minimum dental loss ratio. The report shall also include |
9 | recommendations with respect to requiring dental health carriers to offer a full range of |
10 | comprehensive dental benefit plans, including but not limited to one hundred percent (100%) |
11 | coverage options. |
12 | (b) The commissioner shall make a special annual assessment against each dental health |
13 | insurance carrier during years 2023, 2024, and 2025 for payment of all reasonable costs and |
14 | expenditures in connection with the study report and related analysis required by this section, no |
15 | greater than the combined maximum total of one hundred fifty thousand dollars ($150,000) per |
16 | year for all carriers. Each annual assessment shall, subject to the foregoing maximum, be deemed |
17 | as reasonably sufficient reimbursement for any costs and expenditures necessary for the |
18 | commissioner to fulfill the commissioners obligations under this section. The sums shall be |
19 | proportionately assessed by the commissioner against each dental health insurance carrier based on |
20 | relative annual fully insured membership enrollment, and may be billed whether or not the study |
21 | report has been completed. The carriers billed for such costs and expenditures shall make payment |
22 | to the commissioner within sixty (60) days of the date invoiced. Assessments made pursuant to this |
23 | section may be credited to the normal operating costs of each dental health insurance carrier, and |
24 | shall be deposited as general revenue. |
25 | SECTION 2. This act shall take effect upon passage. |
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LC005635/SUB A | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- DENTAL INSURANCE LOSS RATIO REPORTING AND | |
STUDY ACT | |
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1 | This act would require, for the reporting years 2023, 2024 and 2025, dental health insurance |
2 | carriers to file with the health insurance commissioner an actuarial memorandum disclosing its |
3 | incurred claims and earned premiums, in order to assist the health insurance commissioner with |
4 | respect to the issuance of a study report and recommendations regarding a dental insurance loss |
5 | ratio. This act would also allow the health insurance commission to assess dental health insurance |
6 | carriers an annual maximum combined amount of one hundred fifty thousand dollars ($150,000) |
7 | to defray the costs of the study report. |
8 | This act would take effect upon passage. |
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LC005635/SUB A | |
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