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In the 2024 General Assembly Session, the Virginia Dental Association advocated for successful legislation requiring dental carriers in Virginia to publicly disclose their “incurred loss ratio” and “actual loss ratio” on an annual basis for coverage written for large employers.

The Virginia Bureau of Insurance asked the carriers to submit their data on a template form, and the report for 2023 has now been posted to the Bureau of Insurance website.

The incurred loss ratio was defined to mean the “incurred claims divided by earned premiums.” The “actual loss ratio” directed carriers to report the total of related state and federal taxes, related licensing and regulatory fees, non-profit community benefit expenditures, fraud or related amounts and other related required state and federal payments.

Once a carrier calculates a total of the amounts reported in any or all of the five categories, that total is subtracted from the direct written premiums and that number is referred to as “adjusted earned premium.” To make the final calculation to reach the “actual loss ratio” the carriers were directed to divide the incurred claims by the adjusted earned premiums. The reporting posted to the BOI website allows a comparison of the “incurred” and “actual” loss ratios.

It should be noted that this reporting does not include self-funded plans or plans in the individual or small group market. Carriers are already required to submit on an annual basis Form 130A filings in the individual and small group market, including an anticipated actual loss ratio.

These forms are available to the public on the SCC filing system, available here: SERFF Filing Access - Virginia. The anticipated actual loss ratio for individual and small group plans will generally be lower than large group because the cost to administer individual and small group plans is historically higher.

The VDA has prepared the following table for ease of reporting, including the three largest dental carriers, representing about 61% of the total large group market share for 2023:

Speaking about the release of the first reporting for large group dental carriers, VDA President Justin Norbo said, “Individual patients and employers alike deserve to know how their dental insurance premiums are being spent. Having access to this data for the first time will allow Virginians to make better-informed choices about their healthcare spending and savings, and will allow policymakers to better understand how Virginia compares to other states that require such reporting.”

“The VDA Board of Directors and Council on Government Affairs will carefully study what information has been released, and we are evaluating options to allow for the release of the component pieces of what was reported by the carriers, rather than a summary. That detail will allow those who make decisions on the purchase of dental plans and policymakers to understand how behaviors change over time and is consistent with the spirit of this reporting and transparency legislation.”

As part of the 2024 legislation, the VDA established a Dental Insurance Grievance Tracker, which has been used to gather information from our members on specific carrier behaviors that create barriers to patient care.

One of the issues reported through the tracker has been addressed by VDA-supported legislation in the 2025 General Assembly, which requires a health insurance carrier to notify the provider in a provider contract if the carrier, or entity completing a transaction on behalf of the carrier, uses a payment method that imposes a transaction or processing fee or similar charge on the provider. The carrier is required to offer at least one alternative payment method that does not impose such a fee or similar charge.

Governor Youngkin signed the legislation on March 21, and it will become effective on July 1.

The Dental Insurance Grievance Tracker is an ongoing tool to notify the VDA of changes in carrier practices, and we encourage our members and their front office team members to promptly report issues as they arise, to inform our continued advocacy for our members and their patients.