Bill Text: IL HB2070 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced) 2023-03-10 - Rule 19(a) / Re-referred to Rules Committee [HB2070 Detail]

Download: Illinois-2023-HB2070-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2070 Introduced , by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED:
New Act
215 ILCS 110/34 from Ch. 32, par. 690.34
Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be referred to as the
Dental Loss Ratio Act.
Section 5. Definitions. As used in this Act:
"Dental care provider" means a dentist who bills for
services in Illinois.
"Dental loss ratio" means the ratio of incurred claims to
earned premiums as calculated using the formula under Section
10 of this Act.
"Dental plan carrier" means an entity subject to the
insurance laws, rules, and regulations of this State or
subject to the jurisdiction of the Director that contracts or
offers to contract to provide, deliver, arrange for, pay for,
or reimburse any of the costs of dental care services,
including an accident and health insurance company, a health
maintenance organization, a limited health service
organization, a dental service plan corporation, a health
services plan corporation, a voluntary health services plan,
or any other entity providing a plan of dental insurance,
dental benefits, or dental health care services.
"Department" means the Department of Insurance.

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"Director" means the Director of Insurance.
"Earned premiums" means the portion of the premium paid in
the reporting year that is intended to provide coverage during
that reporting period.
"Incurred claims" means the claims for which services were
provided in that reporting year. "Incurred claims" includes
claims that were paid in the reporting year plus unpaid claim
reserves for claims paid after the reporting year.
Section 10. Dental loss ratio reporting.
(a) A health insurer or dental plan carrier that issues,
sells, renews, or offers a specialized health insurance policy
covering dental services shall, beginning July 1, 2023,
annually submit to the Department the dental loss ratio
calculated in accordance with subsection (c). The annual
filing shall, at a minimum, include rates, rating schedules,
and supporting documentation, including ratios of incurred
claims to earned premiums for each calendar year since the
plan's issuance. The required information shall be in the form
established by the Department and shall demonstrate that each
plan complies with the minimum dental loss ratio standards.
(b) The annual filing shall be made publicly available on
the Department's website.
(c) Minimum dental loss ratios are calculated by the
following formula: the numerator is equal to the incurred
claims for the dental loss ratio reporting year; and the

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denominator is equal to the earned premiums for the dental
loss ratio reporting year minus taxes and licensing and
regulatory fees.
(d) If the Director decides to conduct an examination
because the Director finds it necessary to verify a health
insurer's or dental plan carrier's representation in a dental
loss ratio report, then the Department shall provide the
health insurer or dental plan carrier with a notification 30
days before the commencement of the examination.
(e) The health insurer or dental plan carrier shall have
30 days after the date of notification to electronically
submit to the Department all requested records specified by
the Department. The Director may extend the time for a health
insurer or dental plan carrier to comply with this examination
upon a finding of good cause.
Section 15. Dental loss ratio requirement.
(a) A health insurer or dental plan carrier that issues,
sells, renews, or offers a specialized health insurance policy
covering dental services shall meet a minimum dental loss
ratio requirement of 80%.
(b) If the minimum dental loss ratio is not met, then the
Department shall require a corrective action plan from the
carrier to return excess premiums.
Section 20. Rulemaking. The Department may adopt rules to

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implement this Act.
Section 25. Exemptions. This Act does not apply to an
insurance policy issued, sold, renewed, or offered for health
care services or coverage provided as a function of the State
of Illinois Medicaid coverage for children or adults or
disability insurance for covered benefits in the single
specialized area of dental-only health care that pays benefits
on a fixed benefit, cash payment-only basis.
Section 90. The Dental Service Plan Act is amended by
changing Section 34 as follows:
(215 ILCS 110/34) (from Ch. 32, par. 690.34)
Sec. 34. No such corporation shall disburse during any one
year, except upon the approval of the Director, a sum greater
than 20% of payments received from subscribers during that
year, as administrative expenses.
The term "administrative expense" as used in this Section
section includes all expenditures for nonprofessional services
and in general all expenses not directly connected with the
payment for dental services, but does not include expenses of
soliciting subscriptions.
(Source: Laws 1965, p. 2179.)
Section 99. Effective date. This Act takes effect upon
becoming law.