By Autumn Shelton, West Virginia Press Association
CHARLESTON, W.Va. – The House Banking and Insurance Committee advanced the amended “West Virginia Medical Loss Ratios for Dental (DLR) Health Care Services Plans Act” on Tuesday, a dental insurance reform bill intended to provide greater transparency regarding dental health care plan premiums.
As explained by counsel, in addition to providing transparency, the bill, HB 5417, also requires “annual reports and remediation if the dental loss ratio falls below a certain percentage.”
According to the bill, the dental loss ratio would be calculated by dividing the sum of the amount for dental services provided to enrollees, the amount “incurred on activities that improve dental care quality” and other claims by the “total amount of premium revenue, excluding federal and state taxes, licensing and regulatory fees paid,” certain nonprofit community expenditures and “other payments required by federal law.”
“Carriers calculate their dental loss ratio . . . and then report those back to the insurance commissioner,” counsel explained. “If their dental loss ratio is outside of the average as calculated by the commissioner, the commissioner is then given authority to investigate the carrier and order them to rebate some of the premiums they’ve collected throughout the year.”
The bill’s lead sponsor, Del. Steve Westfall, R-Jackson, explained the purpose of his bill.
“If you remember last year, we had a dental loss ratio bill that had a percentage in it. It came out of Senate, and I parked it,” Westfall said, adding he was worried about losing the state’s dental plan providers.
He said the bill had been worked on for a year and half.
“Massachusetts put this on the ballot and passed a referendum and put a percentage on it, and so far I think five companies left Massachusetts because they said, ‘We’ve gotta make a profit. We can’t do it.’”
Westfall said that over the summer, the American Dental Association and insurance carriers agreed to the language in this bill because it removes that percentage.
According to information found on the American Dental Association website, the Massachusetts ballot measure, passed in 2022, required “the state’s carriers to spend at least 83% of premium dollars on patient care rather than on administrative costs, salaries and profits.”
“If there is some company pretty much making too much money or that the loss ratio is too high, the commissioner can step in after three years and look at it if there is a complaint,” Westfall said of HB 5417. “This is an agreed to bill that I didn’t think would ever happen.”
HB 5417 is now headed to the House Health and Human Resources Committee for additional consideration.
Next, the committee advanced the amended HB 5241, which would require the state’s insurance commissioner to audit and review first responder post-traumatic stress disorder (PTSD) claims through the WV Public Employees Insurance Agency (PEIA).
According to counsel, first responders include law enforcement officers, paid firefighters, emergency medical technicians, paramedics and emergency dispatchers.
Through the bill, the insurance commissioner would also provide annual reports and reviews to the Interim Joint Health Committee, Interim Committee on PEIA and Insurance, and the Interim Committee on Volunteer Fire Departments and Emergency Medical Services.
The approved amendment strikes the introductory bill’s requirement that the “review shall assess wait time and or delay for in-patient admission and treatment, and present data to assess these patients’ experience for prolonged boarding times in the emergency rooms waiting on admission or transfer to an appropriate bed and any denial of claims.”
This bill is now headed to the Committee on Judiciary for consideration.