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Oklahoma House Bill HB2805

Oklahoma 2025 Regular Session

Oklahoma House Bill HB2805 Compare Versions

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28-ENGROSSED HOUSE
29-BILL NO. 2805 By: Marti, Banning, Stinson,
29+HOUSE OF REPRESENTATIVES - FLOOR VERSION
30+
31+STATE OF OKLAHOMA
32+
33+1st Session of the 60th Legislature (2025)
34+
35+COMMITTEE SUBSTITUTE
36+FOR
37+HOUSE BILL NO. 2805 By: Marti, Banning, Stinson,
3038 and Turner of the House
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3240 and
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3442 Thompson of the Senate
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47+COMMITTEE SUBSTITUTE
3948
4049 An Act relating to dental benefit plans; creating the
4150 Oklahoma Medical Loss Ratios for Dental (DLR) Health
4251 Care Services Plans Act; defining terms; establishing
4352 formula for medical loss ratio; requiring annual
4453 reporting to the Oklahoma Ins urance Department;
4554 establishing process for certain data verification;
4655 providing for rebate calculation; directing rule
4756 promulgation; establishing provisions for rate
4857 determination by Commissioner; requiring certain rate
4958 increase notice; providing for codi fication; and
5059 providing an effective date.
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5665 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
5766 SECTION 1. NEW LAW A new section of law to be codified
5867 in the Oklahoma Statutes as Section 7140 of Title 36, unless there
5968 is created a duplication in numbering, reads as follows:
60-This act shall be known and may be cited as the "Oklahoma
61-Medical Loss Ratios for Dental (DLR) Health Care Services Plans
62-Act".
63-SECTION 2. NEW LAW A new section of law to be codified
64-in the Oklahoma Statutes as Section 7141 o f Title 36, unless there
65-is created a duplication in numbering, reads as follows:
6669
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96+This act shall be known and may be cited as the "Oklahoma
97+Medical Loss Ratios for Dental (DLR) Health Care Services Plans
98+Act".
99+SECTION 2. NEW LAW A new section of law to be co dified
100+in the Oklahoma Statutes as Section 7141 of Title 36, unless there
101+is created a duplication in numbering, reads as follows:
92102 A. As used in this act:
93103 1. "Commissioner" means the Insurance Commissioner of this
94104 state;
95105 2. "Dental carrier" or "carrier" means a dental insurance
96106 company, dental service corporation, dental plan organization
97107 authorized to provide dental benefits, or a health benefits plan
98108 that includes coverage for dental services;
99109 3. "Dental health care service plan" or "plan" means any p lan
100110 that provides coverage for dental health care services to enrollees
101-in exchange for premiums, and does not include plans under Medicaid ,
102-the Children's Health Insurance Program (CHIP) , or employer-
103-sponsored self-funded plans covered by the federal Employee
104-Retirement Income Security Act (ERISA) ; and
111+in exchange for premiums, and does not include plans under Medicaid
112+or Children's Health Insurance Program (CHIP); and
105113 4. "Dental loss ratio" or "DLR" means percentage of premium
106114 dollars spent on patient care as calculated pursuant to subsection B
107115 in this section.
108116 B. The dental loss ratio is calculated by dividing the
109117 numerator by the denominator, where:
110118 1. The numerator is the sum of the amount incurred for clinical
111119 dental services provided to enrollees, the amount incurred on
112-activities that improve dental care quality, and other incurred
113-claims as defined at 45 C.F.R., Section 158.140(a); and
114-2. The denominator is the total amount of premium revenue,
115-excluding federal and state taxes, licensing and regulatory fees
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147+activities that improve dental care quality, and other incurred
148+claims as defined at 45 C.F.R., Section 158.140(a); and
149+2. The denominator is the total amount of premium revenue,
150+excluding federal and state ta xes, licensing and regulatory fees
142151 paid, nonprofit community expenditures as defined at 45 C.F.R.,
143152 Section 158.162(c), and any other payments required by federal law.
144-C. The Commissioner sha ll define by order, rule, or bulletin:
153+C. The Commissioner shall define by rule:
145154 1. Expenditures for clinical dental services;
146155 2. Activities that improve dental care quality, activities
147156 conducted by an issuer intended to improve dental care quality shall
148157 not exceed five percent (5%) of net premium revenue; and
149158 3. Overhead and administrative cost expenditures.
150-D. Overhead and administrative costs sha ll not be included in
151-the numerator.
159+D. The definitions promulgated by rule pursuant to this section
160+shall be consistent with similar definitions that are used for the
161+reporting of medical loss ratios by carriers offering health benefit
162+plans in this state. Overhead and administrative costs shall not be
163+included in the numerator.
152164 SECTION 3. NEW LAW A new section of law to be codified
153165 in the Oklahoma Statutes as Section 7142 of Title 36, unless there
154166 is created a duplication in numbering, reads as follows:
155-A. A carrier that issues, sells, renews, or offers a dental
156-health care service plan contract shall electronically file in the
157-manner and format prescribed by the Commissioner a Dental Loss Ratio
158-(DLR) annual report with the Commissioner , along with any
159-transaction or other filing fees. The Commissioner may create the
160-reporting form or use the federal Medical Loss Ratio (MLR) Annual
161-Reporting Form (CMS-10418) in use for that reporting period . The
162-DLR annual report shall report the DLR calculated in accordance with
163-this act, be organized by market and product type, and include any
164-additional data the Commissioner deems necessary, which shall
165-include but is not limited to, the number of enrollees, the plan
167+A. A carrier that issues, sel ls, renews, or offers a
168+specialized dental health care service plan contract shall file a
169+Dental Loss Ratio (DLR) annual report with the Commissioner that is
170+organized by market and product type and contains the same
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198+information required in the 2013 federa l Medical Loss Ratio (MLR)
199+Annual Reporting Form (CMS -10418). The filing shall also report
200+additional data that includes the number of enrollees, the plan
192201 cost-sharing and deductible amounts, the annual maximum coverage
193202 limit, and the number of enrollees who meet or exceed the annual
194203 coverage limit.
195-B. The DLR annual report shall be filed with the Commissioner
196-no later than May 1, 2026, and annually thereafter no later than May
197-1 of each year. The DLR reporting year shall be for the preceding
198-calendar year during which dental coverage is provided by the plan.
199-All terms used in the DLR annual report shall have the same meaning
200-as used in the federal Public Health Service Act (42 U.S.C., Section
201-300gg-18), Part 158 (commenc ing with 158.101) of Title 45 of the
202-Code of Federal Regulations, and 42 U.S.C., Section 1367.003.
203-C. Every carrier, upon receipt of any inquiry fr om the
204-Commissioner, shall, within twenty (20) days from receipt of the
205-inquiry, furnish the Commissioner wi th an adequate response,
206-including but not limited to any requested documents or information .
204+B. The DLR reporting year shall be for the fiscal year during
205+which dental coverage is provided by the plan. All terms used in
206+the DLR annual report shall have the same meaning as used in the
207+federal Public Health Service Act (42 U.S.C., Section 300gg -18),
208+Part 158 (commencing with 158.101) of Title 45 of the Code of
209+Federal Regulations, and 42 U.S.C., Section 1367.003.
210+C. If data verification of the carrier's representations in the
211+DLR annual report is deeme d necessary, the Commissioner shall
212+provide the carrier with a notification thirty (30) days to submit
213+any information required by the Commissioner.
207214 D. By January 1 of the year after the Commissioner receives the
208215 dental loss ratio information collected pu rsuant to subsection A of
209216 this section, the Commissioner shall make the information, including
210217 the aggregate dental loss ratio and other data reported pursuant to
211-this section, available to the public in a searchable format on the
212-Oklahoma Insurance Department's website that allows members of the
213-public to compare dental loss ratios among carriers by plan type .
214-E. The Commissioner shall report the data in this section to
215-the Legislature.
218+this section, available to the public in a searchable format on a
219+public website that allows members of the public to compare dental
220+loss ratios among carriers by plan type by:
221+1. Posting the information on the division’s website; or
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249+2. Providing the information to the administrator of an all -
250+payer health claims database. If the Commissioner p rovides the
251+information to the administrator, the administrator shall make the
252+information available to the public in a format determined by the
253+Commissioner.
254+E. The Commissioner shall report the data in this section to
255+the Legislature.
242256 SECTION 4. NEW LAW A new section of law to be codified
243257 in the Oklahoma Statutes as Section 7143 of Title 36, unless there
244258 is created a duplication in numbering, reads as follows:
245259 A. The Commissioner shall aggregate dental loss ratios for each
246260 carrier by year pursuant to Section 3 of this act for each market
247261 segment in which the carrier operates. The Commissioner shall
248262 calculate an average dental loss ratio (DLR) for each market segment
249263 using aggregate data for a three -year period including data for the
250264 most recent dental loss ratio reporting year and the data for the
251265 two (2) prior dental loss ratio reporting years.
252266 Newer experience shall be subject to reporting standards defined
253267 in 45 C.F.R., Section 158.121.
254268 B. The Commissioner shall calculate an a verage dental loss
255269 ratio for each market segment using the data pursuant to subsection
256270 A of this section, identify as outliers dental plans that fall
257271 outside one standard deviation of the average dental loss ratio, and
258-report those plans to the Legislature consistent with the manner set
259-forth in subsections D and E of Section 3 of this act.
260-A carrier shall not be considered an outlier if its DLR in a
261-market segment is within three (3) percentage points of the average
262-dental loss ratio. A higher threshold may be set in unique
263-circumstances as determined reasonable by the Commissioner.
264-C. The Commissioner shall investigate those carriers that
265-report a DLR lower than one standard deviation from the mathematical
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299+report those plans to the Legislature consistent with the manner set
300+forth in subsections D and E of Section 3 of this act.
301+A carrier shall not be considered an outlier if its DLR in a
302+market segment is within three (3) percentage points of the average
303+dental loss ratio. A higher threshold m ay be set in unique
304+circumstances as determined reasonable by the Commissioner.
305+C. The Commissioner shall investigate those carriers that
306+report a DLR lower than one standard deviation from the mathematical
292307 average, and may take remediation or enforcement actions against
293308 them, including ordering such carriers to rebate, in a manner
294309 consistent with 45 C.F.R., Part 158(B) of the Affordable Care Act
295310 all premiums paid above such amounts that would have caused said
296311 carrier to have achieved the mathematical aver age of the data
297312 submitted in a given year for a given market segment.
298313 D. The report in subsection B of this section shall be
299314 organized to show year -over-year changes in a carrier’s outlier
300315 status relative to meeting the one (1) standard deviation outlier
301316 standard at subsection B of this section. If the DLR for a carrier
302317 in a market segment does not increase and remains an outlier as
303318 defined in subsection B of this section after two (2) consecutive
304319 years, barring unique circumstances as determined reasonab le by the
305320 Commissioner, the carrier shall be subject to a minimum DLR
306321 percentage by market segment. The Commissioner shall promulgate
307322 rules establishing the DLR percentage based on, at minimum, the
308-average of existing carrier loss ratios by market segment in the
309-state to be effective no sooner than forty -two (42) months after a
310-carrier is determined to be an outlier as defined in this section.
311-E. A carrier subject to remediation in subsections C and D of
312-this section shall provide any rebate owing to a policyholder no
313-later than August 1 of the fiscal year following the year for which
314-the ratio described in s ubsection A of this section was calculated.
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350+average of existing carrier loss ratios by market segment in the
351+state to be effective no sooner than forty -two (42) months after a
352+carrier is determined to be an outlier as defined in this section.
353+E. A carrier subject to remediation in subsections C and D of
354+this section shall provide any rebate owing to a po licyholder no
355+later than March 1 of the fiscal year following the year for which
356+the ratio described in subsection A of this section was calculated.
341357 The Commissioner may establish alternatives to direct rebates to
342358 include premium reductions in the followi ng benefit year.
343359 F. The Commissioner may promulgate rules that create a process
344360 to identify carriers that increase rates in excess of the percentage
345361 increase of the latest dental services Consumer Price Index as
346362 reported through the United States Bureau o f Labor Statistics.
347363 G. The Commissioner shall adopt rules as necessary to
348364 effectuate the provisions of this act.
349365 SECTION 5. This act shall become effective November 1, 2025.
350-Passed the House of Representatives the 26th day of March, 2025.
366+
367+COMMITTEE REPORT BY: COMMITTEE ON COMMERCE AND ECONOMIC DEVELOPMENT
368+OVERSIGHT, dated 03/06/2025 - DO PASS, As Amended and Coauthored.
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353-
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355- Presiding Officer of the House
356- of Representatives
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360-Passed the Senate the _____ day of __________, 2025.
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365- Presiding Officer of the Senate