The proposed bill aims to establish the "Dental Insurance Transparency Act" in West Virginia, which introduces regulations for dental health care service plans. It mandates that dental carriers file annual reports detailing the medical loss ratios (MLR) of their plans, ensuring transparency regarding how patient premiums are spent. The bill defines key terms related to dental insurance, including "dental carrier," "provider," and "medical loss ratio," and outlines the requirements for carriers to provide annual rebates to enrollees if the funds spent on patient care fall below a specified percentage of premium revenue. Specifically, large group plans must maintain an MLR of at least 85%, while individual and small group plans must maintain a minimum of 80%.

Additionally, the bill authorizes various methods of payment for dental services and allows dental carriers to enter into third-party network contracts, provided that certain conditions are met to protect providers' rights. It also requires carriers to maintain transparency regarding third-party access to provider services and to notify providers of any changes in contracts. The legislation includes provisions for rulemaking by the Insurance Commissioner to implement these regulations effectively. Overall, the bill seeks to enhance accountability and transparency 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