The proposed bill, known as the "Dental Insurance Transparency Act," aims to enhance the regulation of dental health care service plans in West Virginia. It introduces a new article to the Code of West Virginia that mandates transparency in the expenditures of patient premiums. Key provisions include requirements for dental carriers to file annual medical loss ratio (MLR) reports, which must detail the percentage of premium funds spent on patient care versus administrative costs. The bill also establishes minimum MLR thresholds—85% for large group plans and 80% for individual and small group plans—beyond which carriers must provide annual rebates to enrollees in the form of premium reductions if their spending on patient care falls short.

Additionally, the bill authorizes various methods of payment for dental services, including credit card and electronic funds transfer, while ensuring that providers are informed of any associated fees. It allows dental carriers to enter into third-party network contracts under specific conditions, ensuring that providers maintain control over access to their services. The legislation also empowers the Insurance Commissioner to propose rules for implementation and allows for emergency rulemaking to address urgent matters. Overall, the bill seeks to improve 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