20-126. Annual dental loss ratio report; posting; definitions

A. Beginning July 1, 2024 and on or before July 1 of each year thereafter, each dental insurer doing business in this state shall file with the department on a standard form issued by the department an annual report on the dental loss ratio for the preceding calendar year. The dental loss ratio annual report shall include the following:

1. A combined dental loss ratio percentage for all individual dental policies.

2. A combined dental 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 dental loss ratios for each dental insurer on the department's 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 dental loss ratios and shall treat all claims, premiums and other data as confidential.

C. For the purposes of this section:

1. "Adjusted incurred annual dental claims" means claims that were incurred for services rendered during the preceding calendar year and paid through March 31 of the following year and liability for claims incurred for services rendered during the preceding calendar year that have not been reported or paid through March 31 of the following calendar year.

2. "Dental insurer" means a dental service corporation pursuant to chapter 4, article 3 of this title, prepaid dental plan organization pursuant to chapter 4, article 7 of this title, health care services organization pursuant to chapter 4, article 9 of this title, disability insurer pursuant to chapter 6, article 4 of this title or group or blanket disability insurer pursuant to chapter 6, article 5 of this title that offers, issues or renews a contract, evidence of coverage or policy covering dental services.

3. "Dental loss ratio percentage" means the ratio, stated as a percentage, of the numerator as prescribed in subdivision (a) of this paragraph to the denominator as prescribed in subdivision (b) of this paragraph.

(a) The numerator is the sum of all of the following:

(i) The adjusted incurred annual dental claims in this state.

(ii) The amount spent by a dental insurer on activities that improve the quality of dental care but does not include expenses for advertising, promotions or donations to charitable foundations.

(iii) The amount of claims identified through fraud reduction efforts.

(b) The denominator is the sum of the annual dental insurance premiums earned in this state, excluding:

(i) The annual incurred federal and state taxes, licensing fees and regulatory fees on dental premiums in this state.

(ii) The annual federal income taxes attributed to the dental line of business for the reporting year.

4. "Dental policies" means a contract, evidence of coverage or policy covering dental services, excluding:

(a) A policy, subscription contract, group or blanket disability insurer contract or evidence of coverage that includes dental benefits that are included in the medical benefits of a policy and not administered as stand-alone dental benefits.

(b) A self-funded employer group health or dental plan.

(c) A plan or group of plans covering dental services for which a dental insurer does not have credible experience, as determined by the director.