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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
HOUSE BILL 3381 By: McEntire
AS INTRODUCED
An Act relating to dental insurance; providing
definitions; specifying calculations for dental loss
ratio; directing the Insurance Commissioner to
promulgate rules; regulating rules; mandating reports
by carrier; directing publication of dental loss
ratio data; mandating legislative reports; providing
for civil penalty; providing rules for insurance
cards; providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PE OPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6170.1 of Title 36, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. "Community benefit expenditure " means an expenditure for an
activity or program, or to an organization, which seeks to achieve
the objectives of improving access to dental services and en hancing
dental public health. Th is includes an activity that:
a. is available broadly to the public and serves low -
income consumers,
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b. reduces geographic, fi nancial, or cultural barri ers to
accessing dental services, and if the activity ceased
to exist would result in access proble ms,
c. addresses oral health workforce shortages, such as
advancing education and training of oral health
professionals, or
d. leverages or enhances dental public health activities;
2. "Dental coverage plan" means a health coverage plan that
includes coverage for the costs of dental care services ;
3. "Dental loss ratio" means the percentage of premium dollars
collected each year for a dental coverage pla n that the dental
coverage plan incurs on dental services provided to an en rollee,
separate from overhead and ad ministrative costs.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6170.2 of Title 36, unless there
is created a duplication in numbering, reads as fol lows:
A. The dental loss ratio is calculated by dividing the
numerator by the denominator , where:
1. The numerator is the sum of the amount incurred for clinical
dental services provided to enrollees, the amount incurred on
activities that improve dental care quality, and the amount of
claims payments identified through fraud reduction eff orts; and
2. The denominator is the total amount of premium revenue,
excluding federal and state taxes, licensing and regulatory fees
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paid, nonprofit community benefit expenditures, and any other
payments required by federal law.
B. The Oklahoma Insurance Commissioner shall define by rule:
1. Expenditures for clinical dental services ;
2. Activities that improve dental services;
3. Overhead and administrative cost expenditures; and
4. Nonprofit community benefit expenditures that are aligned
with exclusion parameters , except that the Commissioner shall ensure
that only expenditures that improve access to dental services or
enhance dental health, and no overhead or adm inistrative costs, are
reported under this section.
C. The definitions promulgated by rule pursuant to this section
must be consistent with similar definitions that are used for the
reporting of medical loss ratios by carriers offering health benefit
plans in the state. Overhead and administrative costs must not be
included in the numerator as described in paragraph 1 of subsection
A of this section.
D. On or before July 31, 2025, and on or before July 31 each
year thereafter, a carrier that issues, sell s, renews, or offers a
dental coverage plan shall file a dental loss ratio form
electronically with the Employees Group Insurance Division of the
Office of Management and Enterprise Services for the preceding
calendar year in which dental coverage was provided by the dental
coverage plan. The Commissioner may create a new reporting form or
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use an existing reporting form to facilitate data collection. The
Commissioner shall ensure that fields are r eported consistently by
carriers. The filing must:
1. Report the calculated dental loss ratio according to the
formula in subsection A of this section ;
2. Separately report each data element ;
3. Report additional data that includes the number of
enrollees, the plan cost-sharing and deductible amounts, the annual
maximum coverage limit, and the number of en rollees who meet or
exceed the annual coverage limit;
4. Report data by market segment and product type, as defined
by rule of the Commissioner; and
5. Be in a form and manner as prescribed by rule of t he
Commissioner.
E. For the report to be submitted on or before July 31, 2025, a
carrier shall also submi t the information required in subsection D
of this section for the plan years 2022 through 2025.
F. If the Commissioner deems that data verificatio n of
carrier's dental loss ratio for a dental coverage plan is n ecessary,
the Commissioner shall give the c arrier at least thirty (30) days
notification prior to beginning the verification proc ess with the
carrier.
G. By January 1 of the year after the Division receives the
dental loss ratio information collected pursuant to subsection D of
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this section, the Division shall make the information, in cluding the
aggregate dental loss ratio and the data reported pursuant to
paragraphs 2 and 3 of subsection D of thi s section, available to the
public in a searchable format on a public website that allows
members of the public to compare dental loss ratios amon g carriers
by plan type by posting the information on the Division's website.
The Division shall report th e data in subsection D of this
section, and if available, subsection H of this section, to the
Oklahoma Legislature.
H. Once the Division has collected the data pursuant to
subsection D of this section for two (2) calendar years, the
Commissioner shall promulgate rules that create a process to
identify any carriers that significantly deviate from a verage dental
loss ratios and to investigate the causes of the deviation. Such
process shall include:
1. Calculating an average dental loss ratio for each mar ket
segment using aggregate data for a three-year period, consisting of
data for the dental loss rati o reporting year that is being reported
and the data for the two (2) prior dental loss ratio reporting
years;
2. Identifying as outliers the dental cover age plans that fall
outside of a set number of standard deviation s from the average
dental loss ratio, as determined by rule of the Commissioner based
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on review of the data and consideration of the impact o f nonprofit
community benefit expenditures on any outlier calculation.
The Commissioner may apply more restric tive standard deviation
metrics over time to prevent declines in the average dental loss
ratio in a market segment and may establish by rule addit ional
criteria for use in identifying outliers.
I. 1. The Commissioner may enforce compliance with the
reporting requirements in this section and i mpose a penalty against
a person who violates this section.
2. The Commissioner may investigate or take en forcement actions
against carriers that are determined to be outliers pursuant to
subsection H of this section and rules adopted pursuant to
subsection H of this section and impose a penalty against a person
who violates this section.
J. The Commissioner may promulgate rules to implement this
section.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6170.3 of Title 36, unless there
is created a duplication in numbering, reads as follows:
The Oklahoma Insurance Commissioner shall adopt rules that
require each carrier that provides a dental coverage plan, as
defined in Section 1 of this act, to issue to covered persons to
whom a dental coverage plan identification card is issued a
standardized written or virtual card containing plan in formation.
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The Commissioner shall adopt rules by March 31, 2025, that describe
the format of the standardized card to be issued by carriers. The
rules establishing the format for the card shall include a standard
size, must require the card to be legible and photocopied, and shall
delineate the information to be contained on the card, incl uding the
following as applicable:
1. The covered person 's name and the applicable plan number;
2. Contact information for th e carrier or dental coverage plan
administrator; and
3. An indication of whether the dental coverage plan is
regulated by the State of Oklahoma.
SECTION 4. This act shall become effective November 1, 2024.
59-2-9188 TJ 01/03/24