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PURPOSE OF SB 137
To mandate coverage for necessary maxillofacial services.
ACTUARIAL STATEMENT
The Fiscal Impact Statement was prepared according to generally accepted actuarial principles and
practices, in compliance with ACT 112. The Statement provides an estimate of the financial and
actuarial effect of the proposed change(s) on the Plans, if possible. The Statement makes no
comment or opinion with regard to the merits of the measure for which the Statement is prepared;
however, any identified technical or mechanical defects have been noted.
We have reviewed the input and results of our analysis for reasonableness and relied upon the data
and information provided by the Plans and their Claims Processing Contractors.
3/13/2023
_________________________________________ _________________
Patrick Klein, FSA, MAAA Date
Vice President
3/13/2023
_________________________________________ __________________
Matthew Kersting, FSA, MAAA Date
Vice President
 PROJECTED COSTS
Plan Design Change Estimated Cost/(Savings)
Plan
EBD No Change No Impact
UOA No Change No Impact
ASU No Change No Impact
AHEC No Change No Impact
NWACC No Change No Impact
SAU No Change No Impact
PRICING APPROACH AND COMMENTS
Senate Bill 137 requires self-insured health plans to cover necessary maxillofacial
services. The bill calls out services that are used to restore and manage the head and
facial structures of an individual that are defective because of disease, trauma, or birth or
developmental deformities. The bill excludes cosmetic procedures as well as traditional
dental care and orthodontic services
Our understanding is that the health plans already cover these necessary maxillofacial
services per the plans responses and language found in their summary plan descriptions
(SPDs). Therefore, we project no cost impact for this bill to the plans shown above.