Req. No. 2491 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1832 By: Rosino
AS INTRODUCED
An Act relating to dental benefit plans; defining
terms; establishing f ormula for medical loss ratio;
requiring annual reporting to the Insurance
Department; establishing process for certain data
verification; exempting certain dental plans from
provisions of act; requiring annual rebate for
certain plan years by certain plans; providing for
rebate calculation; prohibiting certain rate
establishment; directing rule promulgation;
establishing provisions for rate determination by
Insurance Commissioner; requiring cer tain rate
increase notice; providing for codification; and
providing an 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 7140 of Title 36, unless there
is created a duplication in numbe ring, reads as follows:
A. As used in this act:
1. “Earned premium” means all monies paid by an enrollee of a
dental benefit plan or the dental coverage portion of a health
benefit plan as a condition of receiving coverage from the insurer ,
including any fees or other associated contributions;
Req. No. 2491 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
2. “Medical loss ratio (MLR) ” means the minimum percentage of
all premium funds collected by an insurer each year that shall be
spent on actual pati ent care rather than overhead costs ; and
3. “Unpaid claim reserve s” means reserves and liabilities
established to account for claims that were incurred during the MLR
reporting year but were not paid within three (3) months of the end
of the MLR reporting year .
B. The medical loss ratio for a dental benefit plan or the
dental coverage portion of a health benefit pl an shall be determined
by dividing the numerator by the denominator as prescribed in
subsection C of this section.
C. 1. The numerator shall be the amount spent on care. The
amount spent on care shall inclu de:
a. the amount expended for clinical dental ser vices which
are services within the American Dental Association
Code on Dental Procedures and Nomenclature provided to
enrollees which includes payments under dental health
maintenance organization plans with dental provider s
whose services are covered by the contract for dental
clinical services or supplies covered by the contract ;
provided, any overpayment that has already been
received from provid ers shall not be repor ted as a
paid claim. Overpayment received by insurers from
Req. No. 2491 Page 3 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
providers shall be deducted from incurred claim
amounts,
b. unpaid claim reserves, and
c. claim payments recovered by insurers from providers or
enrollees using utilization management efforts,
provided that payments are deducted from incurred
claim amounts.
2. Calculation of the nu merator shall not include :
a. administrative costs including, but not limited to,
infrastructure, personnel costs, or broker payments,
b. amounts paid to third-party vendors for secondary
network savings,
c. amounts paid to third-party vendors for network
development, administrati ve fees, claims processing,
and utilization management, and
d. amounts paid to a provider for professional or
administrative servi ces that do not represent
compensation or reimbursement fo r covered services to
an enrollee including, but not limited to, dental
record copying costs, attorney fees, subrogation
vendor fees, and compensation to paraprofessionals,
janitors, quality as surance analysts, adminis trative
supervisors, secretarie s to dental personnel, and
dental records clerks.
Req. No. 2491 Page 4 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
D. The denominator shall include the total amount of the earned
premium revenues, excluding federal and state taxes and licensing
and regulatory fees paid .
E. On and after the effective date of this act, any dental
benefit plan or the dental coverage portion of a health benefit plan
that issues, sells, renews, or offers coverage for dental service s
shall file a medical loss ratio (MLR) with the Insurance Department
in the manner and for m prescribed by the Department. The MLR
reporting year shall be the calendar year during which dental
coverage is provided by the plan and shall be submitted not later
than July 31 of the calendar year immediately following the
reporting year. The report shall be organized by market and product
type and, where appropriate, contain the same information required
in the 2013 federal Medical Loss Ratio Annual Reporting Form (CMS-
10418). All terms used in the MLR annual report shall have the same
meaning as used in the federal P ublic Health Service Act, 42 U.S.C.,
Section 300gg-18, and 45 CFR Part 158.
F. 1. If data verification of the MLR annual report of a
dental benefit plan or the dental coverage portion of a health
benefit plan is deemed necessary, the Departm ent shall provide the
plan with written notification thirty (30 ) days before the
commencement of the financial examination.
2. The dental benefit plan or the dental coverage portion of a
health benefit plan shall have thirty (30) days from the date of
Req. No. 2491 Page 5 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
notification to submit to the Department all requested data. The
Insurance Commissioner m ay extend the time for a plan to comply with
this subsection upon finding of good cause.
G. The Department shall make all data provided to the
Department pursuant to this section publicly available.
H. The provisions of this act shall not apply to health benefit
plans under Medicaid, the Children’s Health Insurance Program, or to
the state-sponsored health benefit plan s under the insurer known as
HealthChoice.
SECTION 2. NEW LAW A new section of law to be co dified
in the Oklahoma Statutes as Section 7141 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. 1. On and after the effective date of this act, any dental
benefit plan or the dental coverage portion of a health benef it plan
that issues, sells, renews, or offers coverage for dental services
shall provide an annual rebate to each enrollee of the plan, on a
pro rata basis, if the medical loss ratio, excluding federal and
state taxes and licensing or regulatory fees, and after accounting
for payments or receipts for risk adjustment, risk corrido rs, and
reinsurance, is less than at minimum:
a. eighty percent (80%) for group health plans of a large
employer, as defined in 42 U.S.C., Section
18024(b)(1), and
Req. No. 2491 Page 6 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
b. seventy-five percent (75%) for plans offered in the
individual market or group health plans of small
employers, as such terms are defined in 42 U.S.C.,
Section 18024(b)(2).
2. Dental benefit plans and the dental coverage portion of
health benefit plans shall implement the provisions of paragraph 1
of this subsection not later than January 1, 2028.
B. The total amount of an annual rebate required under this
section shall be cal culated in an amount equal to the product of the
amount by which the percentage described in s ubsection A of this
section exceeds the insurer ’s reported ratio describe d in
subsections C and D of Section 1 of this act multiplied by the total
amount of earned premium revenue, excluding federal and state taxes
and licensing or regulatory fees paid, and after taking into account
payments or receipts for risk adjustment, risk corr idors, and
reinsurance.
C. A dental benefit plan or the dental coverage portion of a
health benefit plan shall provide any rebate ow ed to an enrollee no
later than August 1 of the calendar year following the reporting
year for which the r atio described in subsection A of this secti on
was calculated.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7142 of Title 36, unless there
is created a duplicat ion in numbering, reads as follows:
Req. No. 2491 Page 7 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
A. All carriers offering dental coverage shall file group
product base rates and any changes t o group rating factors that are
to be effective on January 1 of the plan year on or before July 1 of
the preceding year.
B. A dental benefit plan or the dental coverage portion of a
health benefit plan that issues, sells, ren ews, or offers coverage
for dental services shall not establish rates for any policyholder
that are excessive, inad equate, or unfairly discriminatory. The
Insurance Commissioner shall promulgate rules to require rate
filings and the submission of adequate documentation and supporting
information including actuarial opinions or certifications that the
rates proposed by den tal plans do not result in the medical loss
ratio (MLR) exceeding the ratios described in subsection A of
Section 2 of this act.
C. 1. If a plan files a base rate change and the
administrative expense s, not including taxes and assessments,
increase by more than the most recent calendar year ’s percentage
increase in the dental servi ces Consumer Price Index for All Urban
Consumers, U.S. city average, not seasonally adjusted , the base rate
shall be deemed excessive and presumptively disapproved.
2. If the plan rate is presumptively disapproved:
a. the carrier shall communicate to all employers and
individuals covered under a group product th at the
proposed increase has been presumptively disapproved
Req. No. 2491 Page 8 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
and is subject to a hearing by the Insurance
Department, and
b. the Department shall conduct a public heari ng.
D. The plan shall submit expected rate increases to the
Commissioner at least sixty (60) days prior to the proposed
implementation of the rates. If the Commissioner does not approve
or disapprove the ra te filings within a sixty-day period, the
carrier may implement an d reasonably rely upon the rates . Provided,
the Commissioner may requi re correction of any deficiencies in the
rate filing upon later review if the rate the carrier charged is
excessive, inadequate, or unfairly discriminatory. A prospective
rate adjustment or rebate as described in Section 2 of this act are
the sole remedies for rate deficiencies. If the Commissioner finds
deficiencies in the rate filing after a sixty -day period, the
Commissioner shall provide notice to the carrier, and the carrier
shall correct the rate on a prospective basis.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7143 of Title 36, unless there
is created a duplication in numbering , reads as follows:
A. Beginning July 1, 20 25, and on or before July 1 of each year
thereafter, each insurer providing dental coverage doing business in
this state shall file with the Insurance Department, in the form and
manner prescribed by the Department, an annual report on the medical
Req. No. 2491 Page 9 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
loss ratio for the preceding calendar year. The medical loss ratio
annual report shall include the following:
1. A combined medical loss ratio percentage for all individual
dental policies; and
2. A combined medical loss ratio percentage for all group
dental policies issued to fully insured groups.
B. Not later than August 1 of each year, the Department shall
post the reported medical loss ratio for each dental insurer on a
publicly available website in a manner that is easily located and
identifiable to the public. The Department may not post the
underlying claims, premiums, and other data used to calculate the
medical loss ratio and shall treat all claims, premiums , and other
data as confidential.
SECTION 5. This act shall become effective No vember 1, 2024.
59-2-2491 RD 1/17/2024 4:37:11 PM