The proposed bill aims to establish the "West Virginia Medical Loss Ratios for Dental (DLR) Health Care Services Plans Act," which introduces new regulations for dental health care service plans in West Virginia. It includes provisions for transparency regarding the expenditure of patient premiums, requiring dental carriers to file annual reports detailing their dental loss ratios (DLR). The DLR is defined as the percentage of premium dollars spent on patient care, and if this ratio falls below a specified threshold, carriers are mandated to issue rebates to patients. The bill also outlines the responsibilities of the Insurance Commissioner in defining terms, collecting data, and ensuring compliance with these regulations.

Additionally, the bill mandates that the Commissioner will aggregate DLR data for each carrier and identify outliers that fall below the average DLR. Carriers that consistently report low DLRs may face remediation actions, including the requirement to rebate excess premiums to policyholders. The legislation also stipulates that the Commissioner will propose rules to implement these provisions by a specified deadline and may enact emergency rules as necessary. Overall, the bill seeks to enhance accountability and transparency in dental health care service plans, ensuring that a greater portion of premium funds is directed towards patient care.

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