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North Dakota House Bill HB1481

North Dakota 2025-2026 Regular Session

North Dakota House Bill HB1481 Compare Versions

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1-Sixty-ninth Legislative Assembly of North Dakota
2-In Regular Session Commencing Tuesday, January 7, 2025
3-HOUSE BILL NO. 1481
4-(Representatives Kasper, Dockter, Koppelman, Louser, Ostlie, D. Ruby)
5-(Senators Bekkedahl, Cleary, Clemens, Hogan, Lee, Paulson)
6-AN ACT to create and enact two new sections to chapter 26.1-36.9 of the North Dakota Century Code,
7-relating to dental insurer rate requirements and reporting; and to provide an effective date.
1+25.1250.04000
2+Sixty-ninth
3+Legislative Assembly
4+of North Dakota
5+Introduced by
6+Representatives Kasper, Dockter, Koppelman, Louser, Ostlie, D. Ruby
7+Senators Bekkedahl, Cleary, Clemens, Hogan, Lee, Paulson
8+A BILL for an Act to create and enact two new sections to chapter 26.1-36.9 of the North Dakota
9+Century Code, relating to dental insurer rate requirements and reporting; and to provide an
10+effective date.
811 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
9-SECTION 1. A new section to chapter 26.1-36.9 of the North Dakota Century Code is created and
10-enacted as follows:
12+SECTION 1. A new section to chapter 26.1-36.9 of the North Dakota Century Code is
13+created and enacted as follows:
1114 Dental insurer rates - Approval.
12-1.The commissioner may deem a proposed plan rate of a dental insurer to be excessive and
13-disapprove the proposed plan rate if the dental insurer files a rate change and the:
14-a.Administrative expense component, not including taxes and assessments, increases
15-from the previous year's rate filing by more than four percent;
15+1.The commissioner may deem a proposed plan rate of a dental insurer to be excessive
16+and disapprove the proposed plan rate if the dental insurer files a rate change and the:
17+a.Administrative expense component, not including taxes and assessments,
18+increases from the previous year's rate filing by more than four percent;
1619 b.Reported contribution to surplus exceeds two percent of total revenue; or
1720 c.Dental loss ratio for the plan is less than seventy-five percent.
18-2.a.If the annual dental loss ratio for a dental benefit plan is less than seventy-five percent,
19-the dental insurer offering the plan shall refund the excess premium to covered
20-individuals and groups. As used in this section, "dental loss ratio" means the ratio used to
21-determine the minimum percentage of all premium funds collected by a dental insurer
22-each year which must be spent on actual patient care rather than overhead costs. This
23-minimum required percentage that dental benefit plans must meet for the portion of
24-patient premiums must be dedicated to patient care rather than administrative and
25-overhead costs or the difference must be refunded as provided in this section.
26-b.A dental insurer shall provide notice to all individuals and groups that were covered under
27-the plan during the applicable twelve-month period that such individuals and groups are
28-entitled to a refund on the premium, or if the individual or group remains covered by the
29-dental insurer, that the individual or group is eligible for a credit on the premium for the
30-following twelve-month period.
31-c.The total of all refunds issued under this subsection must equal the amount of the dental
32-insurer's earned premium which exceeds the amount necessary to achieve a dental loss
33-ratio of seventy-five percent, calculated using data reported by the dental insurer.
34-d.The dental loss ratio is calculated by dividing the numerator by the denominator as
35-follows:
21+2.a.If the annual dental loss ratio for a dental benefit plan is less than seventy-five
22+percent, the dental insurer offering the plan shall refund the excess premium to
23+covered individuals and groups. As used in this section, "dental loss ratio" means
24+the ratio used to determine the minimum percentage of all premium funds
25+collected by a dental insurer each year which must be spent on actual patient
26+care rather than overhead costs. This minimum required percentage that dental
27+benefit plans must meet for the portion of patient premiums must be dedicated to
28+patient care rather than administrative and overhead costs or the difference must
29+be refunded as provided in this section.
30+Page No. 1 25.1250.04000
31+ENGROSSED HOUSE BILL NO. 1481
32+FIRST ENGROSSMENT
33+with Senate Amendments
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57+b.A dental insurer shall provide notice to all individuals and groups that were
58+covered under the plan during the applicable twelve-month period that such
59+individuals and groups are entitled to a refund on the premium, or if the individual
60+or group remains covered by the dental insurer, that the individual or group is
61+eligible for a credit on the premium for the following twelve-month period.
62+c.The total of all refunds issued under this subsection must equal the amount of the
63+dental insurer's earned premium which exceeds the amount necessary to
64+achieve a dental loss ratio of seventy-five percent, calculated using data reported
65+by the dental insurer.
66+d.The dental loss ratio is calculated by dividing the numerator by the denominator
67+as follows:
3668 (1)The numerator is the amount spent on care, which must include:
37-(a)The amount expended for clinical dental services that are services within the
38-code on dental procedures and nomenclature, provided to enrollees which
39-includes payments under capitation contracts with dental providers, whose
40-services are covered by the contract for dental clinical services or supplies
41-covered by the contract; H. B. NO. 1481 - PAGE 2
69+(a)The amount expended for clinical dental services that are services
70+within the code on dental procedures and nomenclature, provided to
71+enrollees which includes payments under capitation contracts with
72+dental providers, whose services are covered by the contract for
73+dental clinical services or supplies covered by the contract;
4274 (b)Unpaid claim reserves; and
43-(c)Any claim payment recovered by insurers from providers or enrollees using
44-utilization management efforts, which are deducted from incurred claims
45-amounts.
46-(2)Any overpayment received from a provider may not be reported as a paid claim.
47-Overpayment recoveries received from a provider must be deducted from incurred
48-claims amounts.
75+(c)Any claim payment recovered by insurers from providers or enrollees
76+using utilization management efforts, which are deducted from
77+incurred claims amounts.
78+(2)Any overpayment received from a provider may not be reported as a paid
79+claim. Overpayment recoveries received from a provider must be deducted
80+from incurred claims amounts.
4981 (3)The calculation of the numerator does not include:
50-(a)All administrative costs, including infrastructure, personnel costs, or broker
51-payments;
82+(a)All administrative costs, including infrastructure, personnel costs, or
83+broker payments;
5284 (b)Amounts paid to third-party vendors for secondary network savings;
53-(c)Amounts paid to third-party vendors for network development, administrative
54-fees, claims processing, and utilization management; or
55-(d)Amounts paid to providers for professional or administrative services that do
56-not represent compensation or reimbursement for covered services provided
57-to an enrollee, including dental record copying costs, attorney fees,
58-subrogation vendor fees, and compensation to paraprofessionals, janitors,
59-quality assurance analysts, administrative supervisors, secretaries to dental
60-personnel, and dental record clerks.
85+(c)Amounts paid to third-party vendors for network development,
86+administrative fees, claims processing, and utilization management; or
87+Page No. 2 25.1250.04000
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119+(d)Amounts paid to providers for professional or administrative services
120+that do not represent compensation or reimbursement for covered
121+services provided to an enrollee, including dental record copying
122+costs, attorney fees, subrogation vendor fees, and compensation to
123+paraprofessionals, janitors, quality assurance analysts, administrative
124+supervisors, secretaries to dental personnel, and dental record clerks.
61125 (4)(a)The denominator is calculated using insurer revenue.
62-(b)The earned premium is all monies paid by a policyholder or subscriber as a
63-condition of receiving coverage from the issuer, including any fees or other
64-contributions associated with the dental benefit plan.
126+(b)The earned premium is all monies paid by a policyholder or subscriber
127+as a condition of receiving coverage from the issuer, including any
128+fees or other contributions associated with the dental benefit plan.
65129 (c)The denominator is the total amount of the earned premium revenues,
66-excluding federal and state taxes and licensing and regulatory fees paid after
67-accounting for any payments pursuant to federal law.
130+excluding federal and state taxes and licensing and regulatory fees
131+paid after accounting for any payments pursuant to federal law.
68132 3.The commissioner may:
69-a.Authorize a waiver or adjustment of the refund requirements in this section only if it is
70-determined by the commissioner that issuing refunds would result in financial impairment
71-for the dental insurer.
133+a.Authorize a waiver or adjustment of the refund requirements in this section only if
134+it is determined by the commissioner that issuing refunds would result in financial
135+impairment for the dental insurer.
72136 b.Adopt rules to implement and administer this section.
73-4.This section does not apply to a dental insurer with one thousand enrollees or less cumulative
74-of all plans based on a three - year average.
75-SECTION 2. A new section to chapter 26.1-36.9 of the North Dakota Century Code is created and
76-enacted as follows:
137+4.This section does not apply to a dental insurer with one thousand enrollees or less
138+cumulative of all plans based on a three - year average.
139+SECTION 2. A new section to chapter 26.1-36.9 of the North Dakota Century Code is
140+created and enacted as follows:
77141 Dental loss ratio transparency - Annual report to the commissioner.
78-1.A dental insurer that issues, sells, renews, or offers a specialized dental health care service
79-plan contract shall file a dental loss ratio report with the commissioner by April thirtieth of each
80-year, in a manner prescribed by the commissioner. H. B. NO. 1481 - PAGE 3
81-2.The dental loss ratio report must include dental loss ratio information for the last calendar year
82-for a dental benefit plan provided by a dental insurer and be organized by market and product
83-type.
84-3.The commissioner may request the dental insurer provide data verification of any information
85-provided by the dental insurer in the dental loss ratio report. The dental insurer shall provide
86-data verification to the commissioner within thirty days of the request.
87-4.The commissioner shall make the information provided in the dental loss ratio annual reports
88-filed under this section available on the department's website, including the aggregate dental
89-loss ratio, in a manner that allows the public to compare dental loss ratios among dental
90-insurers by market type.
91-5.For purposes of this section, "dental loss ratio" has the same meaning as in section 1 of this
92-Act.
93-SECTION 3. EFFECTIVE DATE. Section 1 of this Act becomes effective on July 1, 2027. H. B. NO. 1481 - PAGE 4
94-____________________________ ____________________________
95-Speaker of the House President of the Senate
96-____________________________ ____________________________
97-Chief Clerk of the House Secretary of the Senate
98-This certifies that the within bill originated in the House of Representatives of the Sixty-ninth Legislative
99-Assembly of North Dakota and is known on the records of that body as House Bill No. 1481.
100-House Vote: Yeas 88 Nays 3 Absent 3
101-Senate Vote:Yeas 40 Nays 7 Absent 0
102-____________________________
103-Chief Clerk of the House
104-Received by the Governor at ________M. on _____________________________________, 2025.
105-Approved at ________M. on __________________________________________________, 2025.
106-____________________________
107-Governor
108-Filed in this office this ___________day of _______________________________________, 2025,
109-at ________ o’clock ________M.
110-____________________________
111-Secretary of State
142+1.A dental insurer that issues, sells, renews, or offers a specialized dental health care
143+service plan contract shall file a dental loss ratio report with the commissioner by April
144+thirtieth of each year, in a manner prescribed by the commissioner.
145+2.The dental loss ratio report must include dental loss ratio information for the last
146+calendar year for a dental benefit plan provided by a dental insurer and be organized
147+by market and product type.
148+3.The commissioner may request the dental insurer provide data verification of any
149+information provided by the dental insurer in the dental loss ratio report. The dental
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183+insurer shall provide data verification to the commissioner within thirty days of the
184+request.
185+4.The commissioner shall make the information provided in the dental loss ratio annual
186+reports filed under this section available on the department's website, including the
187+aggregate dental loss ratio, in a manner that allows the public to compare dental loss
188+ratios among dental insurers by market type.
189+5.For purposes of this section, "dental loss ratio" has the same meaning as in section 1
190+of this Act.
191+SECTION 3. EFFECTIVE DATE. Section 1 of this Act becomes effective on July 1, 2027.
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