The proposed bill aims to enhance transparency in dental health care service plans in West Virginia by introducing a new article titled "Dental Insurance Transparency Act." It 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." Additionally, it establishes requirements for payment methods to dental providers, allowing for electronic payments while ensuring providers are informed of any associated fees.

Furthermore, the bill authorizes dental carriers to enter into third-party network contracts, provided that the dental care providers consent to such arrangements. It also stipulates that if a carrier fails to meet the minimum MLR—set at 85% for large group plans and 80% for individual or small group plans—annual rebates must be issued to enrollees in the form of premium reductions. The legislation includes provisions for rulemaking by the Insurance Commissioner to implement these requirements effectively. Overall, the bill seeks to improve accountability and financial transparency in dental insurance practices.

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