This bill aims to enhance transparency and accountability in dental health care service plans in West Virginia by introducing a new article to the Code of West Virginia. It establishes definitions for key terms related to dental carriers and health care service plans, mandates annual reporting of medical loss ratios (MLR) to the Insurance Commissioner, and requires carriers to provide rebates to enrollees if the MLR falls below 85%. The bill also prohibits certain restrictions on payment methods to dental providers and outlines the conditions under which dental carriers may enter into third-party network contracts.

Additionally, the bill emphasizes the need for clear communication regarding payment methods and ensures that any contractual clauses that conflict with the new provisions are void. It mandates that dental carriers maintain transparency by providing detailed information about their payment methodologies and the third parties accessing their services. The Insurance Commissioner is granted authority to enforce these regulations and propose rules to implement the article effectively. Overall, the bill seeks to protect consumers by ensuring that a significant portion of premium funds is directed towards patient care rather than administrative costs.

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