Bill > H951

This bill aims to increase transparency and patient rights within dental benefit plans by establishing new regulations for "carriers," which include various types of insurance companies and health organizations offering dental coverage. Key provisions require carriers to submit detailed financial information, including expenses related to administration, marketing, and claims, to the Commissioner of Insurance. The bill also mandates specific medical loss ratios (MLRs), meaning a certain percentage of premiums must be spent on actual dental care rather than administrative costs, with higher MLRs required in later years, and requires carriers to refund excess premiums if these ratios are not met. Furthermore, it sets minimum coverage standards, such as covering 100% of preventative and diagnostic services for adults and children, a minimum annual benefit limit of $1,000, and allowing unused benefits to be carried over to the next year. The bill also addresses contracts between carriers and dentists, requiring fair reimbursement methodologies and allowing patients to direct payments to dentists who are not contracted with the carrier but meet credentialing criteria. Finally, it mandates the development of uniform methodologies for calculating and reporting MLRs for dental plans.