1 STATE OF OKLAHOMA
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2 2nd Session of the 59th Legislature (2024)
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3 HOUSE BILL 3381 By: McEntire
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6 AS INTRODUCED
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7 An Act relating to dental insurance; providing
7 definitions; specifying calculations for dental loss
8 ratio; directing the Insurance Commissioner to
8 promulgate rules; regulating rules; mandating reports
9 by carrier; directing publication of dental loss
9 ratio data; mandating legislative reports; providing
10 for civil penalty; providing rules for insurance
10 cards; providing for codification; and providing an
11 effective date.
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14 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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15 SECTION 1. NEW LAW A new section of law to be codified
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16 in the Oklahoma Statutes as Section 6170.1 of Title 36, unless there
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17 is created a duplication in numbering, reads as follows:
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18 As used in this act:
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19 1. "Community benefit expenditure" means an expenditure for an
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20 activity or program, or to an organization, which seeks to achieve
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21 the objectives of improving access to dental services and enhancing
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22 dental public health. This includes an activity that:
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23 a. is available broadly to the public and serves low-
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24 income consumers,
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 1 b. reduces geographic, financial, or cultural barriers to
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2 accessing dental services, and if the activity ceased
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3 to exist would result in access problems,
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4 c. addresses oral health workforce shortages, such as
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5 advancing education and training of oral health
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6 professionals, or
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7 d. leverages or enhances dental public health activities;
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8 2. "Dental coverage plan" means a health coverage plan that
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9 includes coverage for the costs of dental care services;
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10 3. "Dental loss ratio" means the percentage of premium dollars
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11 collected each year for a dental coverage plan that the dental
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12 coverage plan incurs on dental services provided to an enrollee,
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13 separate from overhead and administrative costs.
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14 SECTION 2. NEW LAW A new section of law to be codified
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15 in the Oklahoma Statutes as Section 6170.2 of Title 36, unless there
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16 is created a duplication in numbering, reads as follows:
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17 A. The dental loss ratio is calculated by dividing the
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18 numerator by the denominator, where:
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19 1. The numerator is the sum of the amount incurred for clinical
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20 dental services provided to enrollees, the amount incurred on
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21 activities that improve dental care quality, and the amount of
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22 claims payments identified through fraud reduction efforts; and
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23 2. The denominator is the total amount of premium revenue,
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24 excluding federal and state taxes, licensing and regulatory fees
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 1 paid, nonprofit community benefit expenditures, and any other
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2 payments required by federal law.
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3 B. The Oklahoma Insurance Commissioner shall define by rule:
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4 1. Expenditures for clinical dental services;
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5 2. Activities that improve dental services;
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6 3. Overhead and administrative cost expenditures; and
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7 4. Nonprofit community benefit expenditures that are aligned
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8 with exclusion parameters, except that the Commissioner shall ensure
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9 that only expenditures that improve access to dental services or
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10 enhance dental health, and no overhead or administrative costs, are
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11 reported under this section.
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12 C. The definitions promulgated by rule pursuant to this section
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13 must be consistent with similar definitions that are used for the
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14 reporting of medical loss ratios by carriers offering health benefit
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15 plans in the state. Overhead and administrative costs must not be
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16 included in the numerator as described in paragraph 1 of subsection
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17 A of this section.
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18 D. On or before July 31, 2025, and on or before July 31 each
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19 year thereafter, a carrier that issues, sells, renews, or offers a
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20 dental coverage plan shall file a dental loss ratio form
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21 electronically with the Employees Group Insurance Division of the
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22 Office of Management and Enterprise Services for the preceding
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23 calendar year in which dental coverage was provided by the dental
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24 coverage plan. The Commissioner may create a new reporting form or
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 1 use an existing reporting form to facilitate data collection. The
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2 Commissioner shall ensure that fields are reported consistently by
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3 carriers. The filing must:
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4 1. Report the calculated dental loss ratio according to the
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5 formula in subsection A of this section;
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6 2. Separately report each data element;
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7 3. Report additional data that includes the number of
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8 enrollees, the plan cost-sharing and deductible amounts, the annual
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9 maximum coverage limit, and the number of enrollees who meet or
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10 exceed the annual coverage limit;
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11 4. Report data by market segment and product type, as defined
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12 by rule of the Commissioner; and
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13 5. Be in a form and manner as prescribed by rule of the
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14 Commissioner.
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15 E. For the report to be submitted on or before July 31, 2025, a
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16 carrier shall also submit the information required in subsection D
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17 of this section for the plan years 2022 through 2025.
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18 F. If the Commissioner deems that data verification of
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19 carrier's dental loss ratio for a dental coverage plan is necessary,
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20 the Commissioner shall give the carrier at least thirty (30) days
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21 notification prior to beginning the verification process with the
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22 carrier.
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23 G. By January 1 of the year after the Division receives the
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24 dental loss ratio information collected pursuant to subsection D of
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 1 this section, the Division shall make the information, including the
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2 aggregate dental loss ratio and the data reported pursuant to
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3 paragraphs 2 and 3 of subsection D of this section, available to the
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4 public in a searchable format on a public website that allows
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5 members of the public to compare dental loss ratios among carriers
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6 by plan type by posting the information on the Division's website.
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7 The Division shall report the data in subsection D of this
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8 section, and if available, subsection H of this section, to the
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9 Oklahoma Legislature.
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10 H. Once the Division has collected the data pursuant to
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11 subsection D of this section for two (2) calendar years, the
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12 Commissioner shall promulgate rules that create a process to
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13 identify any carriers that significantly deviate from average dental
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14 loss ratios and to investigate the causes of the deviation. Such
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15 process shall include:
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16 1. Calculating an average dental loss ratio for each market
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17 segment using aggregate data for a three-year period, consisting of
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18 data for the dental loss ratio reporting year that is being reported
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19 and the data for the two (2) prior dental loss ratio reporting
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20 years;
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21 2. Identifying as outliers the dental coverage plans that fall
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22 outside of a set number of standard deviations from the average
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23 dental loss ratio, as determined by rule of the Commissioner based
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 1 on review of the data and consideration of the impact of nonprofit
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2 community benefit expenditures on any outlier calculation.
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3 The Commissioner may apply more restrictive standard deviation
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4 metrics over time to prevent declines in the average dental loss
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5 ratio in a market segment and may establish by rule additional
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6 criteria for use in identifying outliers.
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7 I. 1. The Commissioner may enforce compliance with the
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8 reporting requirements in this section and impose a penalty against
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9 a person who violates this section.
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10 2. The Commissioner may investigate or take enforcement actions
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11 against carriers that are determined to be outliers pursuant to
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12 subsection H of this section and rules adopted pursuant to
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13 subsection H of this section and impose a penalty against a person
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14 who violates this section.
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15 J. The Commissioner may promulgate rules to implement this
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16 section.
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17 SECTION 3. NEW LAW A new section of law to be codified
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18 in the Oklahoma Statutes as Section 6170.3 of Title 36, unless there
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19 is created a duplication in numbering, reads as follows:
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20 The Oklahoma Insurance Commissioner shall adopt rules that
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21 require each carrier that provides a dental coverage plan, as
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22 defined in Section 1 of this act, to issue to covered persons to
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23 whom a dental coverage plan identification card is issued a
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24 standardized written or virtual card containing plan information.
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 1 The Commissioner shall adopt rules by March 31, 2025, that describe
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2 the format of the standardized card to be issued by carriers. The
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3 rules establishing the format for the card shall include a standard
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4 size, must require the card to be legible and photocopied, and shall
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5 delineate the information to be contained on the card, including the
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6 following as applicable:
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7 1. The covered person's name and the applicable plan number;
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8 2. Contact information for the carrier or dental coverage plan
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9 administrator; and
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10 3. An indication of whether the dental coverage plan is
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11 regulated by the State of Oklahoma.
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12 SECTION 4. This act shall become effective November 1, 2024.
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14 59-2-9188 TJ 01/03/24
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