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ENGROSSED HOUSE
BILL NO. 2805 By: Marti, Banning, Stinson,
and Turner of the House
and
Thompson of the Senate
An Act relating to dental benefit plans; creating the
Oklahoma Medical Loss Ratios for Dental (DLR) Health
Care Services Plans Act; d efining terms; establishing
formula for medical loss ratio; requiring annual
reporting to the Oklahoma Insurance Department;
establishing process for certain data verification;
providing for rebate calculation; directing rule
promulgation; establishing pro visions for rate
determination by Commissioner; requiring certain 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 numbering, reads as follows:
This act shall be known and may be cited as the "Oklahoma
Medical Loss Ratios for Dental (DLR) Health Care Services Plans
Act".
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7141 o f Title 36, unless there
is created a duplication in numbering, reads as follows:
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A. As used in this act:
1. "Commissioner" means the Insurance Commissioner of this
state;
2. "Dental carrier" or "carrier" means a dental insurance
company, dental service corporation, dental plan organization
authorized to provide dental benefits, or a health benefits plan
that includes coverage for dental services;
3. "Dental health care service plan" or "plan" means any plan
that provides coverage for dental health care services to enrollees
in exchange for premiums, and does not include plans under Medicaid ,
the Children's Health Insurance Program (CHIP) , or employer-
sponsored self-funded plans covered by the federal Employee
Retirement Income Security Act (ERISA) ; and
4. "Dental loss ratio" or "DLR" means percentage of premium
dollars spent on patient care as calculated pur suant to subsection B
in this section.
B. 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 other incurred
claims as defined at 45 C.F.R., Section 158.140(a); 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 expenditures as defined at 45 C.F.R.,
Section 158.162(c), and any other payments required by federal law.
C. The Commissioner sha ll define by order, rule, or bulletin:
1. Expenditures for clinical dental services;
2. Activities that im prove dental care quality, activities
conducted by an issuer intended to improve dental care quality shall
not exceed five percent (5%) of net premium revenue; and
3. Overhead and administrative cost expenditures.
D. Overhead and administrative costs sha ll not be included in
the numerator.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Sect ion 7142 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. A carrier that issues, sells, renews, or offers a dental
health care service plan contract shall electronically file in the
manner and format prescribed by the Commissioner a Dental Loss Ratio
(DLR) annual report with the Commissioner , along with any
transaction or other filing fees. The Commissioner may create the
reporting form or use the federal Medical Loss Ratio (MLR) Annual
Reporting Form (CMS-10418) in use for that reporting period . The
DLR annual report shall report the DLR calculated in accordance with
this act, be organized by market and product type, and include any
additional data the Commissioner deems necessary, which shall
include but is not limited to, the number of enrollees, the plan
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cost-sharing and deductible amounts, the annual maximum coverage
limit, and the number of enrollees who meet or exceed the annual
coverage limit.
B. The DLR annual report shall be filed with the Commissioner
no later than May 1, 2026, and annually thereafter no later than May
1 of each year. The DLR reporting year shall be for the preceding
calendar year during which dental coverage is provided by the plan.
All terms used in the DLR annual report shall have the same meaning
as used in the federal Public Health Service Act (42 U.S.C., Section
300gg-18), Part 158 (commenc ing with 158.101) of Title 45 of the
Code of Federal Regulations, and 42 U.S.C., Section 1367.003.
C. Every carrier, upon receipt of any inquiry fr om the
Commissioner, shall, within twenty (20) days from receipt of the
inquiry, furnish the Commissioner wi th an adequate response,
including but not limited to any requested documents or information .
D. By January 1 of the year after the Commissioner receives the
dental loss ratio information collected pursuant to subsection A of
this section, the Commissione r shall make the information, including
the aggregate dental loss ratio and other data reported pursuant to
this section, available to the public in a searchable format on the
Oklahoma Insurance Department's website that allows members of the
public to compare dental loss ratios among carriers by plan type .
E. The Commissioner shall report the data in this section to
the Legislature.
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SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7143 of T itle 36, unless there
is created a duplication in numbering, reads as follows:
A. The Commissioner shall aggregate dental loss ratios for each
carrier by year pursuant to Section 3 of this act for each market
segment in which the carrier operates. The Co mmissioner shall
calculate an average dental loss ratio (DLR) for each market segment
using aggregate data for a three -year period including data for the
most recent dental loss ratio reporting year and the data for the
two (2) prior dental loss ratio repo rting years.
Newer experience shall be subject to reporting standards defined
in 45 C.F.R., Section 158.121.
B. The Commissioner shall calculate an average dental loss
ratio for each market segment using the data pursuant to subsection
A of this section, identify as outliers dental plans that fall
outside one standard deviation of the average dental loss ratio, and
report those plans to the Legislature consistent with the manner set
forth in subsections D and E of Section 3 of this act.
A carrier shall not be considered an outlier if its DLR in a
market segment is within three (3) percentage points of the average
dental loss ratio. A higher threshold may be set in unique
circumstances as determined reasonable by the Commissioner.
C. The Commissioner shall investigate those carriers that
report a DLR lower than one standard deviation from the mathematical
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average, and may take remediation or enforcement actions against
them, including ordering such carriers to rebate, in a manner
consistent with 45 C.F.R., Part 158(B) of the Affordable Care Act
all premiums paid above such amounts that would have caused said
carrier to have achieved the mathematical av erage of the data
submitted in a given year for a given market segment.
D. The report in subsection B of th is section shall be
organized to show year -over-year changes in a carrier’s outlier
status relative to meeting the one (1) standard deviation outlier
standard at subsection B of this section. If the DLR for a carrier
in a market segment does not increase and remains an outlier as
defined in subsection B of this section after two (2) consecutive
years, barring unique circumstances as determined reason able by the
Commissioner, the carrier shall be subject to a minimum DLR
percentage by market segment. The C ommissioner shall promulgate
rules establishing the DLR percentage based on, at minimum, the
average of existing carrier loss ratios by market segment in the
state to be effective no sooner than forty -two (42) months after a
carrier is determined to be an outlier as defined in this section.
E. A carrier subject to remediation in subsections C and D of
this section shall provide any rebate owing to a policyholder no
later than August 1 of the fiscal year following the year for which
the ratio described in s ubsection A of this section was calculated.
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The Commissioner may establish alternatives to direct rebates to
include premium reductions in the following benefit year.
F. The Commissioner may promulgate rules that create a process
to identify carriers tha t increase rates in excess of the percentage
increase of the latest dental services Consumer Price Index as
reported through the United States Burea u of Labor Statistics.
G. The Commissioner shall adopt rules as necessary to
effectuate the provisions of t his act.
SECTION 5. This act shall become effective November 1, 2025.
Passed the House of Representatives the 26th day of March, 2025.
Presiding Officer of the House
of Representatives
Passed the Senate the _____ day of __________, 2025.
Presiding Officer of the Senate