SLS 24RS-1297 ENGROSSED
2024 Regular Session
SENATE BILL NO. 463
BY SENATOR WHEAT
DENTAL HEALTH. Creates the Louisiana Dental Loss Ratios for Dental Healthcare
Services Plans Act. (1/1/25)
1 AN ACT
2 To enact Subpart H of Part III of Chapter 4 of Title 22 of the Louisiana Revised Statutes of
3 1950, to be comprised of R.S. 22:1161 through 1166, relative to dental healthcare
4 plans; to provide for transparency of expenditures of dental healthcare plan
5 premiums; to require an annual report; to require rules; to provide for an effective
6 date; and to provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. Subpart H of Part III of Chapter 4 of Title 22 of the Louisiana Revised
9 Statutes of 1950, comprised of R.S. 22:1161 through 1166, is hereby enacted to read as
10 follows:
11 SUBPART H. LOUISIANA DENTAL LOSS RATIOS F OR DENTAL
12 HEALTHCARE SERVICES P LANS ACT
13 §1161. Short title
14 This Subpart shall be cited as the "Louisiana Dental Loss Ratios for
15 Dental Healthcare Services Plans Act".
16 §1162. Purpose
17 The purpose of this Subpart is to provide for transparency of the
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 463
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1 expenditures of dental healthcare service plan premiums and to require annual
2 reports.
3 §1163. Definitions
4 As used in this Subpart, the following definitions apply:
5 (1) "Dental carrier" or "carrier" means a dental insurance company,
6 dental service corporation, dental plan organization authorized to provide
7 dental benefits, or a health insurance plan that includes coverage for dental
8 services.
9 (2) "Dental healthcare service plan" or "plan" means any plan that
10 provides coverage for dental healthcare services to enrollees in exchange for
11 premiums.
12 (3) "Dental loss ratio" means a percentage of premium dollars spent on
13 patient care as calculated pursuant to R.S. 22:1164.
14 §1164. Dental loss ratio calculations
15 The dental loss ratio is calculated by dividing the numerator by the
16 denominator as follows:
17 (1)(a) The numerator is the sum of the amount incurred for clinical
18 dental services provided to enrollees, the amount incurred on activities that
19 improve dental care quality, and other incurred claims as defined in 45 CFR
20 158.140(a).
21 (b) The activities to improve dental care quality shall not exceed five
22 percent of the carrier's net revenue.
23 (c) Administrative and overhead costs shall not be included in the
24 numerator.
25 (2) The denominator is the total amount of premium revenue except for
26 federal and state taxes, licensing and regulatory fees paid, and any nonprofit
27 community expenditures, as defined in 45 CFR 158.162(c), and any other
28 payments required by federal law.
29 §1165. Transparency of patient premium expenditures; dental loss ratio annual
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1 report
2 A. In order to provide transparency of patient premium expenditures for
3 dental healthcare services, all carriers that renew, deliver, or issue a dental
4 healthcare service plan in this state shall file a dental loss ratio annual report
5 for the preceding calendar year to the commissioner no later than March 1,
6 2025, and annually thereafter, no later than June thirtieth of each calendar
7 year.
8 B. The dental loss ratio annual report shall comply with all of the
9 following:
10 (1) Be organized by market and product type.
11 (2) Contain the same information as required by the 2013 Centers for
12 Medicare and Medicaid Services Medical Loss Ratio Annual Reporting Form
13 (CMS-10418).
14 (3) Provide the number of enrollees, the plan cost-sharing, deductible
15 amounts, the annual maximum coverage limit, and the number of enrollees who
16 meet or exceed the annual coverage limit.
17 C. Any terms used in the dental loss ratio annual report shall have the
18 same meaning as used in the Public Health Service Act, 42 U.S.C. 300gg-18 and
19 Part 158 of Title 45 of the Code of Federal Regulations.
20 D. If the commissioner finds that additional information is needed to
21 verify a plan's representation of its data, the commissioner shall provide a
22 written notice to the carrier that requests this additional information. The
23 carrier shall have thirty days from receipt of the notice to submit the additional
24 information.
25 E. The dental loss ratio annual report filed with the commissioner shall
26 be made available to the public no later than June 30, 2025, and annually
27 thereafter, no later than June thirtieth of each calendar year. The commissioner
28 shall post the dental loss ratio in a searchable format on the department's
29 website.
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1 F. The commissioner shall file a report on the data collected pursuant to
2 this Section with the Senate Committee on Insurance and the House Committee
3 on Insurance, and a copy of the report shall be forwarded to the David R.
4 Poynter Legislative Research Library as required by R.S. 24:771 and 772, no
5 later than June 30, 2025, and annually thereafter, no later than June thirtieth
6 of each calendar year.
7 G. The provisions of this Subpart shall not apply to plans under
8 Medicaid or the Louisiana Children's Health Insurance Program.
9 §1166. Rulemaking
10 The commissioner shall promulgate rules and regulations as necessary
11 to implement the provisions of this Subpart, including but not limited to
12 definitions of eligible clinical dental services, activities to improve dental care
13 quality, and administrative and overhead cost expenditures.
14 Section 2. This Act shall become effective on January 1, 2025.
The original instrument was prepared by Beth O'Quin. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Amanda Trapp.
DIGEST
SB 463 Engrossed 2024 Regular Session Wheat
Proposed law creates the "La. Dental Loss Ratios for Dental Healthcare Services Plans Act".
Proposed law provides definitions for "dental carrier", "dental healthcare service plan", and
"dental loss ratio".
Proposed law requires dental carriers to file an annual report for dental loss ratios to the
commissioner of insurance (commissioner) no later than March 1, 2025, and annually
thereafter, no later than March 1st of each calendar year.
Proposed law provides the information that is required to be included for the dental loss ratio
annual report.
Proposed law provides the commissioner may request additional information from the carrier
to verify the annual report data.
Proposed law requires the dental ratio report be published in a searchable format on the
Dept. of Insurance's website no later than June 30, 2025, and annually thereafter, no later
than June 30th of each calendar year.
Proposed law requires the commissioner to promulgate rules to effectuate proposed law.
Effective January 1, 2025.
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words in boldface type and underscored are additions. SB NO. 463
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(Adds R.S. 22:1161-66)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill
1. Changes dates for the insurers to provide information to the commissioner
and for the commissioner to publish the information on Dept. of Insurance's
website.
2. Makes technical changes.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.