The proposed bill aims to enhance transparency in dental health care service plans by introducing the "Dental Insurance Transparency Act." It establishes a new article in the Code of West Virginia that mandates dental carriers to file annual reports detailing their medical loss ratios (MLR), which reflect the percentage of premium funds spent on patient care versus administrative costs. The bill outlines specific definitions related to dental insurance, including terms like "dental carrier," "provider," and "medical loss ratio." It also requires carriers to provide detailed information about enrollees, plan costs, and coverage limits in their annual reports, which will be made publicly available.

Additionally, the bill sets forth regulations regarding payment methods for dental services, allowing carriers to use electronic payments while ensuring providers are informed of any associated fees. It authorizes dental carriers to enter into third-party network contracts under certain conditions and prohibits them from terminating provider contracts based on a provider's refusal to allow third-party access. Furthermore, if a carrier fails to meet the established MLR thresholds—85% for large group plans and 80% for individual or small group plans—it must issue annual rebates to enrollees in the form of premium reductions. The bill also empowers the Insurance Commissioner to propose rules and emergency regulations to implement these provisions effectively.

Statutes affected:
Introduced Version: 33-64-1, 33-64-2, 33-64-3, 33-64-4, 33-64-5, 33-64-6, 33-64-7