For Immediate Release
January 31, 2024
Contact: Pat Gilbert
NCOIL HEALTH INSURANCE COMMITTEE ADOPTS MEDICAL LOSS RATIOS FOR DENTAL (DLR) HEALTH CARE SERVICES PLANS MODEL ACT
Model Will Provide Guidance to States Seeking to Pass Legislation Related to Dental Loss Ratios
Belmar, NJ – The National Council of Insurance Legislators (NCOIL) Health Insurance & Long Term Care Issues Committee met Friday and adopted the NCOIL Medical Loss Ratios for Dental (DLR) Health Care Services Plans Model Act (Model). The Model is sponsored by West Virgina Delegate Steve Westfall and co-sponsored by Illinois Representative Rita Mayfield.
Del. Westfall said, “I am proud to sponsor this Model as it will ultimately help ensure that dental insurance is affordable and available to consumers. While it took over a year for NCOIL to reach a consensus, I am thrilled that we landed on a version of the Model that the Committee and representatives from both sides could support. I thank the Committee for its patience in listening to and incorporating input from a wide variety of perspectives and I look forward to passing a bill based on this Model in West Virginia and seeing other states do the same.”
Discussions around the Model began last January and it originally required carriers that issue, sell, renew, or offer a specialized dental health care service plan contract to file an MLR annual report with that states’ insurance commissioner, and then provide annual rebates to enrollees if the ratio of the amount of premium revenue expended by the carrier on the costs for reimbursement for services provided to enrollees under that coverage and for activities that improve dental care quality to the total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees, and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance is less than 85%.
However, after several rounds of discussions, the Committee agreed upon a Model that requires dental plans to report DLR information to the insurance commissioner which the commissioner then aggregates for each market segment. The commissioner then calculates an average DLR for each market segment and identifies as “outliers” any dental plans that fall outside a certain scope of that average DLR. The commissioner is then authorized to take enforcement actions against those “outliers,” including ordering them to issue rebates. If a carrier remains an “outlier” for two consecutive years, that carrier is then subject to a minimum DLR percentage as determined by the commissioner via rule.
The American Dental Association (ADA) and the National Association of Dental Plans (NADP) issued a joint statement supporting the Model. The statement can be viewed here:
“The Committee has worked diligently for over a year to develop a Model that is well thought out and incorporates a wide range of policy perspectives,” said Utah Representative Jim Dunnigan, Chair of the Committee. “While there was a lot of debate on this issue, thanks to Del. Westfall’s leadership we were able to reach a consensus and produce a Model that will be very useful to legislators across the country.”
“The passage of this Model by the Health Committee is an example of NCOIL at its finest and I was so glad to see it get across the finish line,” said Arkansas Representative Deborah Ferguson, DDS, NCOIL Immediate Past President. “While I certainly hoped to see it pass when I was President last year, it was really important for us to take some more time to hear from more stakeholders and to work to find a solution that has widespread support.”
During the drafting and deliberation process, NCOIL legislators and staff heard from a wide array of interested parties including: the ADA, the American Council of Life Insurers (ACLI), the American Association of Oral and Maxillofacial Surgeons (AAOMS), the California Dental Association (CDA), Delta Dental of California, the Health Benefits Institute (HBI), the NADP, and the Organized Dentistry Coalition (ODC).
“Passing this Model is a great indication that NCOIL is off to a productive 2024. The Committee has worked tirelessly to get the Model to a place where it could be voted on without objection and I’ll be watching with great interest as it gets introduced in legislatures across the country,” said Texas Representative Tom Oliverson, M.D., NCOIL President.
NCOIL CEO Commissioner Tom Considine said, “Kudos to Chair Dunnigan, Delegate Westfall, and everyone involved in passage of this important Model. The Committee put in a significant amount of time and effort to arrive at a solution that would be universally supported and it is clear that it was well worth it. This is yet another example of how NCOIL continues to be a national model of bipartisan cooperation.”
The Model will now be placed on the NCOIL Executive Committee’s consent agenda for final ratification during the NCOIL Spring Meeting in Nashville, TN from April 11 -14.
A full copy of the Model appears here: https://ncoil.org/wp-content/uploads/2024/01/NCOIL-DLR-Model-Health-Cmte-Adopted-1-26-24.pdf
NCOIL is a national legislative organization with the nation’s 50 states as members, represented principally by legislators serving on their states’ insurance and financial institutions committees. NCOIL writes Model Laws in insurance and financial services, works to preserve the State jurisdiction over insurance as established by the McCarran-Ferguson Act over seventy years ago, and to serve as an educational forum for public policymakers and interested parties. Founded in 1969, NCOIL works to assert the prerogative of legislators in making State policy when it comes to insurance and educate State legislators on current and longstanding insurance issues.