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53	53	STATE OF OKLAHOMA
54	54
55	55	2nd Session of the 59th Legislature (2024)
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57	57	SENATE BILL 1832 By: Rosino
58	58
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60	60
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63	63	AS INTRODUCED
64	64
65	65	An Act relating to dental benefit plans; defining
66	66	terms; establishing f ormula for medical loss ratio;
67	67	requiring annual reporting to the Insurance
68	68	Department; establishing process for certain data
69	69	verification; exempting certain dental plans from
70	70	provisions of act; requiring annual rebate for
71	71	certain plan years by certain plans; providing for
72	72	rebate calculation; prohibiting certain rate
73	73	establishment; directing rule promulgation;
74	74	establishing provisions for rate determination by
75	75	Insurance Commissioner; requiring cer tain rate
76	76	increase notice; providing for codification; and
77	77	providing an effective date .
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79	79
80	80
81	81
82	82
83	83	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
84	84	SECTION 1. NEW LAW A new section of law to be codified
85	85	in the Oklahoma Statutes as Section 7140 of Title 36, unless there
86	86	is created a duplication in numbe ring, reads as follows:
87	87	A. As used in this act:
88	88	1. “Earned premium” means all monies paid by an enrollee of a
89	89	dental benefit plan or the dental coverage portion of a health
90	90	benefit plan as a condition of receiving coverage from the insurer ,
91	91	including any fees or other associated contributions;
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143	143	2. “Medical loss ratio (MLR) ” means the minimum percentage of
144	144	all premium funds collected by an insurer each year that shall be
145	145	spent on actual pati ent care rather than overhead costs ; and
146	146	3. “Unpaid claim reserve s” means reserves and liabilities
147	147	established to account for claims that were incurred during the MLR
148	148	reporting year but were not paid within three (3) months of the end
149	149	of the MLR reporting year .
150	150	B. The medical loss ratio for a dental benefit plan or the
151	151	dental coverage portion of a health benefit pl an shall be determined
152	152	by dividing the numerator by the denominator as prescribed in
153	153	subsection C of this section.
154	154	C. 1. The numerator shall be the amount spent on care. The
155	155	amount spent on care shall inclu de:
156	156	a. the amount expended for clinical dental ser vices which
157	157	are services within the American Dental Association
158	158	Code on Dental Procedures and Nomenclature provided to
159	159	enrollees which includes payments under dental health
160	160	maintenance organization plans with dental provider s
161	161	whose services are covered by the contract for dental
162	162	clinical services or supplies covered by the contract ;
163	163	provided, any overpayment that has already been
164	164	received from provid ers shall not be repor ted as a
165	165	paid claim. Overpayment received by insurers from
166	166
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217	217	providers shall be deducted from incurred claim
218	218	amounts,
219	219	b. unpaid claim reserves, and
220	220	c. claim payments recovered by insurers from providers or
221	221	enrollees using utilization management efforts,
222	222	provided that payments are deducted from incurred
223	223	claim amounts.
224	224	2. Calculation of the nu merator shall not include :
225	225	a. administrative costs including, but not limited to,
226	226	infrastructure, personnel costs, or broker payments,
227	227	b. amounts paid to third-party vendors for secondary
228	228	network savings,
229	229	c. amounts paid to third-party vendors for network
230	230	development, administrati ve fees, claims processing,
231	231	and utilization management, and
232	232	d. amounts paid to a provider for professional or
233	233	administrative servi ces that do not represent
234	234	compensation or reimbursement fo r covered services to
235	235	an enrollee including, but not limited to, dental
236	236	record copying costs, attorney fees, subrogation
237	237	vendor fees, and compensation to paraprofessionals,
238	238	janitors, quality as surance analysts, adminis trative
239	239	supervisors, secretarie s to dental personnel, and
240	240	dental records clerks.
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292	292	D. The denominator shall include the total amount of the earned
293	293	premium revenues, excluding federal and state taxes and licensing
294	294	and regulatory fees paid .
295	295	E. On and after the effective date of this act, any dental
296	296	benefit plan or the dental coverage portion of a health benefit plan
297	297	that issues, sells, renews, or offers coverage for dental service s
298	298	shall file a medical loss ratio (MLR) with the Insurance Department
299	299	in the manner and for m prescribed by the Department. The MLR
300	300	reporting year shall be the calendar year during which dental
301	301	coverage is provided by the plan and shall be submitted not later
302	302	than July 31 of the calendar year immediately following the
303	303	reporting year. The report shall be organized by market and product
304	304	type and, where appropriate, contain the same information required
305	305	in the 2013 federal Medical Loss Ratio Annual Reporting Form (CMS-
306	306	10418). All terms used in the MLR annual report shall have the same
307	307	meaning as used in the federal P ublic Health Service Act, 42 U.S.C.,
308	308	Section 300gg-18, and 45 CFR Part 158.
309	309	F. 1. If data verification of the MLR annual report of a
310	310	dental benefit plan or the dental coverage portion of a health
311	311	benefit plan is deemed necessary, the Departm ent shall provide the
312	312	plan with written notification thirty (30 ) days before the
313	313	commencement of the financial examination.
314	314	2. The dental benefit plan or the dental coverage portion of a
315	315	health benefit plan shall have thirty (30) days from the date of
316	316
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367	367	notification to submit to the Department all requested data. The
368	368	Insurance Commissioner m ay extend the time for a plan to comply with
369	369	this subsection upon finding of good cause.
370	370	G. The Department shall make all data provided to the
371	371	Department pursuant to this section publicly available.
372	372	H. The provisions of this act shall not apply to health benefit
373	373	plans under Medicaid, the Children’s Health Insurance Program, or to
374	374	the state-sponsored health benefit plan s under the insurer known as
375	375	HealthChoice.
376	376	SECTION 2. NEW LAW A new section of law to be co dified
377	377	in the Oklahoma Statutes as Section 7141 of Title 36, unless there
378	378	is created a duplication in numbering, reads as follows:
379	379	A. 1. On and after the effective date of this act, any dental
380	380	benefit plan or the dental coverage portion of a health benef it plan
381	381	that issues, sells, renews, or offers coverage for dental services
382	382	shall provide an annual rebate to each enrollee of the plan, on a
383	383	pro rata basis, if the medical loss ratio, excluding federal and
384	384	state taxes and licensing or regulatory fees, and after accounting
385	385	for payments or receipts for risk adjustment, risk corrido rs, and
386	386	reinsurance, is less than at minimum:
387	387	a. eighty percent (80%) for group health plans of a large
388	388	employer, as defined in 42 U.S.C., Section
389	389	18024(b)(1), and
390	390
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441	441	b. seventy-five percent (75%) for plans offered in the
442	442	individual market or group health plans of small
443	443	employers, as such terms are defined in 42 U.S.C.,
444	444	Section 18024(b)(2).
445	445	2. Dental benefit plans and the dental coverage portion of
446	446	health benefit plans shall implement the provisions of paragraph 1
447	447	of this subsection not later than January 1, 2028.
448	448	B. The total amount of an annual rebate required under this
449	449	section shall be cal culated in an amount equal to the product of the
450	450	amount by which the percentage described in s ubsection A of this
451	451	section exceeds the insurer ’s reported ratio describe d in
452	452	subsections C and D of Section 1 of this act multiplied by the total
453	453	amount of earned premium revenue, excluding federal and state taxes
454	454	and licensing or regulatory fees paid, and after taking into account
455	455	payments or receipts for risk adjustment, risk corr idors, and
456	456	reinsurance.
457	457	C. A dental benefit plan or the dental coverage portion of a
458	458	health benefit plan shall provide any rebate ow ed to an enrollee no
459	459	later than August 1 of the calendar year following the reporting
460	460	year for which the r atio described in subsection A of this secti on
461	461	was calculated.
462	462	SECTION 3. NEW LAW A new section of law to be codified
463	463	in the Oklahoma Statutes as Section 7142 of Title 36, unless there
464	464	is created a duplicat ion in numbering, reads as follows:
465	465
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516	516	A. All carriers offering dental coverage shall file group
517	517	product base rates and any changes t o group rating factors that are
518	518	to be effective on January 1 of the plan year on or before July 1 of
519	519	the preceding year.
520	520	B. A dental benefit plan or the dental coverage portion of a
521	521	health benefit plan that issues, sells, ren ews, or offers coverage
522	522	for dental services shall not establish rates for any policyholder
523	523	that are excessive, inad equate, or unfairly discriminatory. The
524	524	Insurance Commissioner shall promulgate rules to require rate
525	525	filings and the submission of adequate documentation and supporting
526	526	information including actuarial opinions or certifications that the
527	527	rates proposed by den tal plans do not result in the medical loss
528	528	ratio (MLR) exceeding the ratios described in subsection A of
529	529	Section 2 of this act.
530	530	C. 1. If a plan files a base rate change and the
531	531	administrative expense s, not including taxes and assessments,
532	532	increase by more than the most recent calendar year ’s percentage
533	533	increase in the dental servi ces Consumer Price Index for All Urban
534	534	Consumers, U.S. city average, not seasonally adjusted , the base rate
535	535	shall be deemed excessive and presumptively disapproved.
536	536	2. If the plan rate is presumptively disapproved:
537	537	a. the carrier shall communicate to all employers and
538	538	individuals covered under a group product th at the
539	539	proposed increase has been presumptively disapproved
540	540
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591	591	and is subject to a hearing by the Insurance
592	592	Department, and
593	593	b. the Department shall conduct a public heari ng.
594	594	D. The plan shall submit expected rate increases to the
595	595	Commissioner at least sixty (60) days prior to the proposed
596	596	implementation of the rates. If the Commissioner does not approve
597	597	or disapprove the ra te filings within a sixty-day period, the
598	598	carrier may implement an d reasonably rely upon the rates . Provided,
599	599	the Commissioner may requi re correction of any deficiencies in the
600	600	rate filing upon later review if the rate the carrier charged is
601	601	excessive, inadequate, or unfairly discriminatory. A prospective
602	602	rate adjustment or rebate as described in Section 2 of this act are
603	603	the sole remedies for rate deficiencies. If the Commissioner finds
604	604	deficiencies in the rate filing after a sixty -day period, the
605	605	Commissioner shall provide notice to the carrier, and the carrier
606	606	shall correct the rate on a prospective basis.
607	607	SECTION 4. NEW LAW A new section of law to be codified
608	608	in the Oklahoma Statutes as Section 7143 of Title 36, unless there
609	609	is created a duplication in numbering , reads as follows:
610	610	A. Beginning July 1, 20 25, and on or before July 1 of each year
611	611	thereafter, each insurer providing dental coverage doing business in
612	612	this state shall file with the Insurance Department, in the form and
613	613	manner prescribed by the Department, an annual report on the medical
614	614
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665	665	loss ratio for the preceding calendar year. The medical loss ratio
666	666	annual report shall include the following:
667	667	1. A combined medical loss ratio percentage for all individual
668	668	dental policies; and
669	669	2. A combined medical loss ratio percentage for all group
670	670	dental policies issued to fully insured groups.
671	671	B. Not later than August 1 of each year, the Department shall
672	672	post the reported medical loss ratio for each dental insurer on a
673	673	publicly available website in a manner that is easily located and
674	674	identifiable to the public. The Department may not post the
675	675	underlying claims, premiums, and other data used to calculate the
676	676	medical loss ratio and shall treat all claims, premiums , and other
677	677	data as confidential.
678	678	SECTION 5. This act shall become effective No vember 1, 2024.
679	679
680	680	59-2-2491 RD 1/17/2024 4:37:11 PM

Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1832 Compare Versions