News
On April 17, Governor Inslee approved Washington House Bill 1002,
which includes two primary sections to require carriers offering
dental-only plans to submit information on loss ratios and to prohibit
dental plans from denying coverage for treatment of emergency dental
conditions that would otherwise be covered on the basis that the
services were provided on the same day of examination and diagnosis. The
dental loss ratio (DLR) submissions mirror similar reports required of
medical carriers in the state, but will be made publicly available in a
searchable format (current Medical Loss Ratio (MRL) search function available online here).
The
legislation as passed represents months of collaboration and negotiation
between stakeholders and dental carriers in the state. The original
bill text would have required dental plans to meet current MLR
standards; applied guaranteed renewability and availability standards to
dental; prohibited carriers from denying certain services; and required
similar reimbursement for providers in and out of network.
The law
becomes effective January 1, 2017, with reports on 2016 loss ratio data
presumably due April 1, 2017. Further discussion with the Office of the
Insurance Commissioner (OIC) may help to further define terms and
calculations of certain terms in the legislation, such as “revenue” and
“dental payments.”
