The proposed bill aims to reform the dental benefits system in Washington by prohibiting unfair and deceptive practices by dental insurance companies, thereby prioritizing patient choice and access to care. It seeks to align dental insurance protections with those already established for medical insurance, ensuring that patients have the same rights and protections. Key provisions include allowing patients to choose their dentist without network restrictions, mandating that a certain percentage of premium dollars be spent on care, and enabling patients to request independent reviews of denied claims. The bill also addresses inequities in the dental benefits system, particularly for vulnerable populations, by creating a more transparent market that improves access to care and reduces out-of-pocket costs.

Additionally, the bill introduces several new sections to existing laws, including provisions that require limited health care service contractors to allow dentists to make decisions on patient care without interference from insurance companies. It also mandates that dental insurers provide alternative payment methods that do not impose fees on providers and requires health carriers to submit information on dental loss ratios and administrative expenses. The bill establishes a framework for the insurance commissioner to disapprove excessive or unreasonable plan rates and mandates refunds for carriers with a dental loss ratio below 85 percent. Overall, the legislation aims to create a fairer dental insurance market that benefits patients and providers alike.

Statutes affected:
Original Bill: 48.44.035, 48.44.495, 48.43.743