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SENATE FLOOR VERSION
April 2, 2024
AS AMENDED
ENGROSSED HOUSE
BILL NO. 3381 By: Echols, McEntire, and
Wallace of the House
and
Haste of the Senate
[ dental insurance - dental loss ratio - rules -
reports - publication - civil penalty - codification
- effective date ]
BE IT ENACTED BY THE PEOPLE 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 enhancing
dental public health. This includes an activity that:
a. is available broadly to the public and serves low -
income consumers,
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b. reduces geographic, financial, or cultural barriers to
accessing dental services, and if the activity ceased
to exist would result in access problems,
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 t hat
includes coverage fo r the costs of dental care services;
3. "Dental loss ratio" means the percentage of premium dollars
collected each year for a dental coverage plan that the dental
coverage plan incurs on dental services provided to an enrollee,
separate from overhead and administrative 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 follows:
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 quali ty, and the amount of
claims payments identified through fraud reduction efforts ; 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 expenditure s, 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 administrative 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, sells, 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 reported consistently by
carriers. The filing must:
1. Report the calculated dental loss rati o 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 enrollees 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 the
Commissioner.
E. For the report to b e submitted on or before July 31, 2025, a
carrier shall also submit the information required in subsection D
of this section for the plan years 2022 through 2025.
F. If the Commissioner deems that data verification of
carrier's dental loss ratio for a dental coverage plan is necessary,
the Commissioner shall give the carrier at least thirty (30) days
notification prior to beginning the verification process with the
carrier.
G. By January 1 of the year after the Division receives th e
dental loss ratio info rmation collected pursuant to subsection D of
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this section, the Division shall post the separated dental loss
ratios for each dental insurer on a publicly available website in a
manner that is easily accessible and identifiable to t he public.
The Division shall not post the underlying claims, premiums, and
other data used to calculate the dental loss ratios and shall treat
all claims, premiums, and other data used to calculate the ratio as
confidential.
The Division shall report the 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 pro mulgate rules that create a process to
identify any carriers that significantly deviate from average dental
loss ratios and to investigate the causes of the deviation. Such
process shall include:
1. Calculating an average dental loss ratio for each marke t
segment using aggregat e data for a three-year period, consisting of
data for the dental loss ratio 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 coverage plans that fall
outside of a set number of standard deviations 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 of nonprofit
community benefit expenditures on any out lier 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 additional
criteria for use in identifying outliers.
I. 1. The Commissioner may enforce compliance with the
reporting requirements in this section and impose a penalty against
a person who violates this section.
2. The Commissioner may investigate or take enforcement actions
against carriers that are determine d to be outliers pursuan t 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 th at
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 information.
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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 photoc opied, and shall
delineate the information to be contained on the card, including the
following as applicable:
1. The covered person 's name and the applicable plan number;
2. Contact information for the 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.
COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
April 2, 2024 - DO PASS AS AMENDED