The proposed bill introduces the "Dental Insurance Transparency Act," which aims to enhance the regulation of dental health care service plans in West Virginia. It establishes new requirements for dental carriers, including the need to file annual medical loss ratio (MLR) reports that detail how patient premiums are spent. The bill mandates that if a carrier spends less than a specified percentage of premium revenue on patient care, they must provide annual rebates to enrollees in the form of premium reductions. Additionally, the bill outlines the definitions of key terms related to dental insurance, such as "dental carrier," "provider," and "medical loss ratio," and sets minimum MLR thresholds of 85% for large group plans and 80% for individual and small group plans.

Furthermore, the bill authorizes various methods of payment for dental services and allows dental carriers to enter into third-party network contracts, provided certain conditions are met. It requires transparency in these contracts, including advance notification to providers about third-party access to their services and the maintenance of an updated list of such third parties. The bill also empowers the Insurance Commissioner to propose rules for legislative approval and to enact emergency rules to ensure the effective implementation of the new regulations. Overall, the legislation seeks to improve transparency and accountability in dental insurance practices, ultimately benefiting consumers.

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