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Bring Dental Insurance Transparency to Virginia

Jan 16, 2024
1/16/2024 2:55 PM
 

The Issue: It is unclear how much of a patient’s annual premium is spent on actual dental care in Virginia 

  • Transparency in how dental plans are structured and how much a plan pays out over time in claims will give employers and patients information that can be used to make informed decisions in how they will pay for essential dental care.
  • Health insurance carriers are required by the ACA to spend at least 80% of patient premiums on patient care – dental plans have no such requirement. Meanwhile, Dental insurers in Virginia are not currently required to publicly report the actual ratio of claims paid to the premium revenue they take in the large group market.
  • This lack of transparency could lead employers to partner with hollow dental plans and no easy way to understand what portion of their premiums go to insurance company overhead/profits.

The Solution: Support Virginia Dental Association Legislation for Transparency and Reporting

Senate Bill 257 will increase transparency and accountability in dental insurance by requiring dental insurance carriers to disclose their Actual Loss Ratio (ALR) annually in the large group, small group and individual markets.

What will this legislation require?

  • The Bureau of Insurance (BOI) will post annual dental insurance carriers ALRs on their website. A two-year lookback will allow patients and employers to understand and compare trends among dental insurance companies and how much of their premium dollars are spent on dental care.
  • A work group will also be convened of stakeholders including dental carriers to evaluate the need for changes regarding ethics and fairness in dental carrier business practices. 

How will Virginians benefit from this legislation?

  • It will enable employers and patients to make informed decisions with regards to their healthcare dollars. This bill requires uniform reporting so that dentists and patients can make informed decisions. 
  • It will incentivize the dental plans to encourage patients to actually USE the benefit.
  • Transparency and accountability will protect patients and provide incentives for insurers to operate efficiently.
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