Oklahoma 2024 Regular Session

Oklahoma House Bill HB3381 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3		-	SENATE FLOOR VERSION - HB3381 SFLR Page 1
4		-	(Bold face denotes Committee Amendments) 1
	3	+	ENGR. H. B. NO. 3381 Page 1 1
5	4		2
6	5		3
7	6		4
8	7		5
9	8		6
10	9		7
11	10		8
12	11		9
13	12		10
14	13		11
15	14		12
16	15		13
17	16		14
18	17		15
19	18		16
20	19		17
21	20		18
22	21		19
23	22		20
24	23		21
25	24		22
26	25		23
27	26		24
28	27
29		-	SENATE FLOOR VERSION
30		-	April 2, 2024
31		-	AS AMENDED
32		-
33	28		ENGROSSED HOUSE
34	29		BILL NO. 3381 By: Echols, McEntire, and
35	30		Wallace of the House
36	31
37	32		and
38	33
39	34		Haste of the Senate
40	35
41	36
42	37
43	38
44	39
45		-	[ dental insurance - dental loss ratio - rules -
46		-	reports - publication - civil penalty - codification
47		-	- effective date ]
	40	+
	41	+
	42	+	An Act relating to dental insurance; providing
	43	+	definitions; specifying calculations for dental loss
	44	+	ratio; directing the Insurance Commissioner to
	45	+	promulgate rules; regulating rules; mandating reports
	46	+	by carrier; directing publication of dental loss
	47	+	ratio data; mandating legislative reports; providing
	48	+	for civil penalty; providing rules for insurance
	49	+	cards; providing for codification; and providing an
	50	+	effective date.
48	51
49	52
50	53
51	54
52	55
53	56		BE IT ENACTED BY THE PE OPLE OF THE STATE OF OKLAHOMA:
54	57		SECTION 1. NEW LAW A new section of law to be codified
55	58		in the Oklahoma Statutes as Section 6170.1 of Title 36, unless there
56	59		is created a duplication in numbering, reads as follows:
57	60		As used in this act:
58	61		1. "Community benefit expenditure " means an expenditure for an
59	62		activity or program, or to an organization, which seeks to achieve
60	63		the objectives of improving access to dental services an d enhancing
61	64		dental public health. Th is includes an activity that:
62		-	a. is available broadly to the public and serves low -
63		-	income consumers,
64	65
65		-	SENATE FLOOR VERSION - HB3381 SFLR Page 2
66		-	(Bold face denotes Committee Amendments) 1
	66	+	ENGR. H. B. NO. 3381 Page 2 1
67	67		2
68	68		3
69	69		4
70	70		5
71	71		6
72	72		7
73	73		8
74	74		9
75	75		10
76	76		11
77	77		12
78	78		13
79	79		14
80	80		15
81	81		16
82	82		17
83	83		18
84	84		19
85	85		20
86	86		21
87	87		22
88	88		23
89	89		24
90	90
	91	+	a. is available broadly to the public and serves low -
	92	+	income consumers,
91	93		b. reduces geographic, fi nancial, or cultural barri ers to
92	94		accessing dental services, and if the activity ceased
93	95		to exist would result in access problems,
94	96		c. addresses oral health workforce shortages, such as
95	97		advancing education and training of oral health
96	98		professionals, or
97	99		d. leverages or enhances dental public health activities;
98	100		2. "Dental coverage plan" means a health coverage plan that
99	101		includes coverage for the costs of dental care services ;
100	102		3. "Dental loss ratio" means the percentage of premium dollars
101	103		collected each year for a dental coverage pla n that the dental
102	104		coverage plan incurs on dental services provided to a n enrollee,
103	105		separate from overhead and ad ministrative costs.
104	106		SECTION 2. NEW LAW A new section of law to be codified
105	107		in the Oklahoma Statutes as Section 6170.2 of Title 36, unless there
106	108		is created a duplication in numbering, reads as follows:
107	109		A. The dental loss ratio is calculated by dividing the
108	110		numerator by the denominator , where:
109	111		1. The numerator is the sum of the amount incurred for clinical
110	112		dental services provided to enrollees, the amount incurred on
111	113		activities that improve dental care quality, and the amount of
112	114		claims payments identified through fraud reduction eff orts; and
113		-	2. The denominator is the total amount of premium revenue,
114		-	excluding federal and state taxes, licensing and regulatory fees
115	115
116		-	SENATE FLOOR VERSION - HB3381 SFLR Page 3
117		-	(Bold face denotes Committee Amendments) 1
	116	+	ENGR. H. B. NO. 3381 Page 3 1
118	117		2
119	118		3
120	119		4
121	120		5
122	121		6
123	122		7
124	123		8
125	124		9
126	125		10
127	126		11
128	127		12
129	128		13
130	129		14
131	130		15
132	131		16
133	132		17
134	133		18
135	134		19
136	135		20
137	136		21
138	137		22
139	138		23
140	139		24
141	140
	141	+	2. The denominator is the total amount of premium revenue,
	142	+	excluding federal and state taxes, licensing and regulatory fees
142	143		paid, nonprofit community bene fit expenditures, and any other
143	144		payments required by federal law.
144	145		B. The Oklahoma Insurance Commissioner shall define by rule:
145	146		1. Expenditures for clinical dental services ;
146	147		2. Activities that improve dental services;
147	148		3. Overhead and administrative cost expenditures; and
148	149		4. Nonprofit community benefit expenditures that are aligned
149	150		with exclusion parameters , except that the Commissioner shall ensure
150	151		that only expenditures that improve access to dental services or
151	152		enhance dental health, and no overhead or administrative costs, are
152	153		reported under this section.
153	154		C. The definitions promulgated by rule pursuant to this section
154	155		must be consistent with similar definitions that are used for the
155	156		reporting of medical loss ratios by carriers offering health benefit
156	157		plans in the state. Overhead and administrative costs must not be
157	158		included in the numerator as described in paragraph 1 of subsection
158	159		A of this section.
159	160		D. On or before July 31, 2025, and on or before July 31 each
160	161		year thereafter, a carrier that issues, sells, renews, or offers a
161	162		dental coverage plan shall file a dental loss ratio form
162	163		electronically with the Employees Group Insurance Division of the
163	164		Office of Management and Enterprise Services for the preceding
164		-	calendar year in which dental coverage was provided by the dental
165		-	coverage plan. The Commissioner may create a new reporting form or
166	165
167		-	SENATE FLOOR VERSION - HB3381 SFLR Page 4
168		-	(Bold face denotes Committee Amendments) 1
	166	+	ENGR. H. B. NO. 3381 Page 4 1
169	167		2
170	168		3
171	169		4
172	170		5
173	171		6
174	172		7
175	173		8
176	174		9
177	175		10
178	176		11
179	177		12
180	178		13
181	179		14
182	180		15
183	181		16
184	182		17
185	183		18
186	184		19
187	185		20
188	186		21
189	187		22
190	188		23
191	189		24
192	190
	191	+	calendar year in which dental coverage was provided by the dental
	192	+	coverage plan. The Commissioner may create a new reporting form or
193	193		use an existing reporting form to facilitate data collection. The
194	194		Commissioner shall ensure that fields are reported consistently by
195	195		carriers. The filing must:
196	196		1. Report the calculated dental loss ratio according to the
197	197		formula in subsection A of this section ;
198	198		2. Separately report each data element ;
199	199		3. Report additional data that includes the number of
200	200		enrollees, the plan cost-sharing and deductible amounts, the annual
201	201		maximum coverage limit, and the number of en rollees who meet or
202	202		exceed the annual coverage limit;
203	203		4. Report data by market segment and product type, as defined
204	204		by rule of the Commissioner; and
205	205		5. Be in a form and manner as prescribed by rule of t he
206	206		Commissioner.
207	207		E. For the report to be submitted on or before July 31, 2025, a
208	208		carrier shall also submi t the information required in subsection D
209	209		of this section for the plan years 2022 through 2025.
210	210		F. If the Commissioner deems that data verificatio n of
211	211		carrier's dental loss ratio for a dental coverage plan is n ecessary,
212	212		the Commissioner shall give the c arrier at least thirty (30) days
213	213		notification prior to beginning the verification proc ess with the
214	214		carrier.
215		-	G. By January 1 of the year after the Division receives th e
216		-	dental loss ratio info rmation collected pursuant to subsection D of
217	215
218		-	SENATE FLOOR VERSION - HB3381 SFLR Page 5
219		-	(Bold face denotes Committee Amendments) 1
	216	+	ENGR. H. B. NO. 3381 Page 5 1
220	217		2
221	218		3
222	219		4
223	220		5
224	221		6
225	222		7
226	223		8
227	224		9
228	225		10
229	226		11
230	227		12
231	228		13
232	229		14
233	230		15
234	231		16
235	232		17
236	233		18
237	234		19
238	235		20
239	236		21
240	237		22
241	238		23
242	239		24
243	240
244		-	this section, the Division shall post the separated dental loss
245		-	ratios for each dental insurer on a publicly available website in a
246		-	manner that is easily accessible and identifiable to t he public.
247		-	The Division shall not post the underlying claims, premiums, and
248		-	other data used to calculate the dental loss ratios and shall treat
249		-	all claims, premiums, and other data used to calculate the ratio as
250		-	confidential.
	241	+	G. By January 1 of the year after the Division receives the
	242	+	dental loss ratio information collected pursuant to subsection D of
	243	+	this section, the Division shall make the information, in cluding the
	244	+	aggregate dental loss ratio and the data reported pursuant to
	245	+	paragraphs 2 and 3 of subsection D of th is section, available to the
	246	+	public in a searchable format on a public website that allows
	247	+	members of the public to compare dental loss ratios amon g carriers
	248	+	by plan type by posting the informatio n on the Division's website.
251	249		The Division shall report th e data in subsection D of this
252	250		section, and if available, subsection H of this section, to the
253	251		Oklahoma Legislature.
254	252		H. Once the Division has collected the data pursuant to
255	253		subsection D of this section for two (2) calendar years, the
256	254		Commissioner shall promulgate rules that create a process to
257	255		identify any carriers that significantly deviate from a verage dental
258	256		loss ratios and to investigate the causes of the deviation. Such
259	257		process shall include:
260	258		1. Calculating an average dental loss ratio for each mar ket
261	259		segment using aggregate data for a three-year period, consisting of
262	260		data for the dental loss rati o reporting year that is being reported
263	261		and the data for the two (2) prior dental loss ratio report ing
264	262		years;
265	263		2. Identifying as outliers the dental cover age plans that fall
266	264		outside of a set number of standard deviation s from the average
267		-	dental loss ratio, as determined by rule of the Commissioner based
268	265
269		-	SENATE FLOOR VERSION - HB3381 SFLR Page 6
270		-	(Bold face denotes Committee Amendments) 1
	266	+	ENGR. H. B. NO. 3381 Page 6 1
271	267		2
272	268		3
273	269		4
274	270		5
275	271		6
276	272		7
277	273		8
278	274		9
279	275		10
280	276		11
281	277		12
282	278		13
283	279		14
284	280		15
285	281		16
286	282		17
287	283		18
288	284		19
289	285		20
290	286		21
291	287		22
292	288		23
293	289		24
294	290
	291	+	dental loss ratio, as determined by rule of the Commissioner based
295	292		on review of the data and consideration of the imp act of nonprofit
296	293		community benefit expenditures on any outlier calculation.
297	294		The Commissioner may apply more restric tive standard deviation
298	295		metrics over time to prevent declines in the average dental loss
299	296		ratio in a market segment and may establish by rule additional
300	297		criteria for use in identifying outliers.
301	298		I. 1. The Commissioner may enforce compliance with the
302	299		reporting requirements in this section and i mpose a penalty against
303	300		a person who violates this section.
304	301		2. The Commissioner may investigate or ta ke enforcement actions
305	302		against carriers that are determined to be outliers pursuant to
306	303		subsection H of this section and rules adopted pursuant to
307	304		subsection H of this section and impose a penalty against a person
308	305		who violates this section.
309	306		J. The Commissioner may promulgate rules to implement this
310	307		section.
311	308		SECTION 3. NEW LAW A new section of law to be codified
312	309		in the Oklahoma Statutes as Section 6170.3 of Title 36, unless there
313	310		is created a duplication in numbering, reads as follows :
314	311		The Oklahoma Insurance Commissioner shall adopt rules that
315	312		require each carrier that provides a dental coverage plan, as
316	313		defined in Section 1 of this act, to issue to covered persons to
317	314		whom a dental coverage plan identification card is issued a
318		-	standardized written or virtual card containing plan information.
319	315
320		-	SENATE FLOOR VERSION - HB3381 SFLR Page 7
321		-	(Bold face denotes Committee Amendments) 1
	316	+	ENGR. H. B. NO. 3381 Page 7 1
322	317		2
323	318		3
324	319		4
325	320		5
326	321		6
327	322		7
328	323		8
329	324		9
330	325		10
331	326		11
332	327		12
333	328		13
334	329		14
335	330		15
336	331		16
337	332		17
338	333		18
339	334		19
340	335		20
341	336		21
342	337		22
343	338		23
344	339		24
345	340
	341	+	standardized written or virtual card containing plan in formation.
346	342		The Commissioner shall adopt rules by March 31, 2025, that describe
347	343		the format of the standardized card to be issued by carriers. The
348	344		rules establishing the format for the card shall include a standard
349	345		size, must require the card to be legible and photocopied, and shall
350	346		delineate the information to be contained on the card, incl uding the
351	347		following as applicable:
352	348		1. The covered person 's name and the applicable plan number;
353	349		2. Contact information f or the carrier or dental coverage plan
354	350		administrator; and
355	351		3. An indication of whether the dental coverage plan is
356	352		regulated by the State of Oklahoma.
357	353		SECTION 4. This act shall become effective November 1, 2024.
358		-	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
359		-	April 2, 2024 - DO PASS AS AMENDED
	354	+	Passed the House of Representatives the 12th day of March, 2024.
	355	+
	356	+
	357	+
	358	+
	359	+	Presiding Officer of the House
	360	+	of Representatives
	361	+
	362	+
	363	+
	364	+	Passed the Senate the ___ day of __________, 2024.
	365	+
	366	+
	367	+
	368	+
	369	+	Presiding Officer of the Senate
	370	+
	371	+