Bill > S566

This bill, titled "Relative to dental benefit plan transparency and patients' Bill of Rights," aims to enhance transparency and patient protections within dental benefit plans offered by various insurers and health organizations in the Commonwealth. Key provisions include requiring carriers, which are defined as entities like insurers, non-profit medical service corporations, dental service corporations, health maintenance organizations, and preferred provider arrangements that offer dental plans, to submit detailed financial information to the Commissioner of the Division of Insurance. This information will include projected administrative expenses, claims operations, marketing, and network costs, with the goal of ensuring that a significant portion of premiums, specifically 90% through December 31, 2016, and 95% thereafter, is spent on actual dental care (known as the medical loss ratio or MLR). If a carrier's MLR falls below these thresholds, they will be required to issue refunds or credits to their members. The bill also mandates that carriers file proposed rate changes annually by July 1st, allowing the Commissioner to disapprove rates that are excessive, inadequate, or unreasonable, and establishes specific requirements for public hearings and potential intervention by the Attorney General if rates are presumptively disapproved. Furthermore, it requires carriers to provide comprehensive annual financial statements, detailing costs by market group size and line of business, and mandates that all dental benefit plans cover 100% of preventative and diagnostic services for individuals aged 18 and older, and both preventative, diagnostic, and basic restorative services for those under 18, with a minimum annual benefit limit of $1,000 and the ability to carry over unused benefits. Finally, the bill 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.