SB 548
Requiring transparency of dental health care insurance products
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- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to increase transparency in West Virginia’s dental health insurance products. It requires dental insurance carriers to report their medical loss ratios (MLR) annually, detailing how much of their premium revenue is spent on patient care versus administrative costs. The bill also establishes rules regarding payment methods to dental providers, prohibits certain contractual restrictions, and mandates annual premium rebates to enrollees if the carrier’s MLR falls below a certain threshold. Finally, it regulates third-party network contracts.
Key provisions
- Requires dental insurance carriers to file annual medical loss ratio (MLR) reports with the Insurance Commissioner.
- Prohibits dental carriers from imposing restrictions on payment methods to dental providers.
- Mandates annual premium rebates to enrollees if the carrier’s MLR is below 85%.
- Authorizes third-party network contracts between dental carriers and third parties.
- Requires carriers to notify providers of any changes to payment methodologies.
- Establishes a process for rulemaking to implement the bill’s provisions.
- Defines key terms related to dental health care service plans and insurance.
- Specifies that Medicaid and CHIP plans are exempt from certain reporting requirements.
Who is affected
- Dental insurance carriers
- Dental care providers
- Dental health insurance enrollees
- The Insurance Commissioner
- Consumers of dental health care services
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