Bill > HB1325

This bill establishes new regulations for dental insurance medical loss ratios (MLR) in Pennsylvania, requiring health insurers to submit annual reports detailing how much of their premium revenue is spent directly on patient dental care. Specifically, the bill mandates that insurers calculate their medical loss ratio by dividing the amount spent on clinical dental services and quality improvement activities by their total premium revenue, excluding certain taxes and fees. Health insurers must submit these reports by April 30th each year, providing detailed information about dental coverage organized by market and product type, consistent with federal reporting standards. The report must break down administrative cost expenditures, which include expenses like marketing, financial administration, and claims operations. The Pennsylvania Insurance Department will publicly post these reports and has the authority to enforce compliance through penalties such as suspending an insurer's license, issuing cease and desist orders, and imposing civil penalties up to $5,000 for each violation (or $10,000 for willful violations), with a maximum aggregate penalty of $500,000 per calendar year. The bill applies to most health insurance policies but excludes specific types of insurance like accident-only, long-term care, and workers' compensation policies. The regulations are designed to increase transparency and ensure that a significant portion of insurance premiums are spent on actual patient dental care rather than administrative costs.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=1325