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 a carrier's DLR falls below a specified threshold, they must issue rebates to patients. The bill also mandates that the Insurance Commissioner create rules to define relevant expenditures and ensure compliance with these new standards.

Additionally, the bill outlines the process for reporting and investigating carriers with low DLRs, including potential remediation actions and the requirement for carriers to provide rebates to policyholders by a specified deadline. The Commissioner is tasked with aggregating DLR data, identifying outlier plans, and reporting findings to the Legislature. The bill emphasizes the need for legislative and emergency rules to implement these provisions effectively, with a deadline for rule proposals set for July 28, 2025. Overall, the legislation seeks to enhance accountability and transparency in dental health care services, ultimately benefiting patients through improved financial practices.

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