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A07852 Summary:

BILL NOA07852
 
SAME ASSAME AS S07013
 
SPONSORWeprin
 
COSPNSRHevesi, Taylor
 
MLTSPNSR
 
Amd §§3231 & 4308, Ins L
 
Establishes a medical loss ratio for dental insurance of not less than 82% for calendar year 2024 and thereafter.
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A07852 Actions:

BILL NOA07852
 
07/07/2023referred to insurance
01/03/2024referred to insurance
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A07852 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7852
 
SPONSOR: Weprin
  TITLE OF BILL: An act to amend the insurance law, in relation to establishing a medical loss ratio for dental insurance   PURPOSE OR GENERAL IDEA OF BILL: To establish a medical loss ratio for dental insurance and ensure that a minimum amount of the premium is spent on patient care.'   SUMMARY OF SPECIFIC PROVISIONS: Section 1 establishes a medical loss ratio of 82% for individual and small group dental insurance products. Section 2 and 3 establish a medical loss ratio of 82% for non-profit medical and dental indemnity corporations' dental insurance products. Section 4 sets an immediate effective date and shall apply to any poli- cies issued or in effect January 1, 2024.   JUSTIFICATION: Under current law, health insurance companies offering small group and individual products must meet a medical loss ratio of 82%, which requires that at least 82% of every premium dollar be spent on patient care. There is no comparable MLR requirement for dental insurance products. This bill would protect consumers by establishing an MLR that parallels existing MLR requirements for health insurance products.   PRIOR LEGISLATIVE HISTORY: This is a new bill.   FISCAL IMPLICATIONS: None to the state.   EFFECTIVE DATE: This act shall take effect on January 1, 2024, and apply to insurance and managed care contracts issued or entered into on or after that date.
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A07852 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7852
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                      July 7, 2023
                                       ___________
 
        Introduced by M. of A. WEPRIN -- read once and referred to the Committee
          on Insurance
 
        AN ACT to amend the insurance law, in relation to establishing a medical
          loss ratio for dental insurance
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1.   Paragraph 3 of subsection (e)  of  section  3231  of  the
     2  insurance  law,  as added by chapter 107 of the laws of 2010, is amended
     3  to read as follows:
     4    (3) (a) All policy forms subject to this subsection, other than  medi-
     5  care  supplemental  insurance  policy  forms, but including policy forms
     6  covering any dental services where a premium is collected, issued or  in
     7  effect during calendar year two thousand ten shall be subject to a mini-
     8  mum  loss  ratio requirement of eighty-two percent. Insurers may use the
     9  alternate filing procedure set forth in paragraph two of this subsection
    10  to adjust premium rates in order to meet the required minimum loss ratio
    11  for calendar year two thousand ten. The rate filing or application shall
    12  be submitted no later than September thirtieth, two thousand ten.
    13    (b) The expected minimum loss ratio for a dental policy  form  subject
    14  to  this  subsection  issued or in effect during and after calendar year
    15  two thousand twenty-four, other than a medicare  supplemental  insurance
    16  contract, shall not be less than eighty-two percent. In reviewing a rate
    17  filing  or  application,  the  superintendent  may modify the eighty-two
    18  percent expected minimum loss ratio requirement  if  the  superintendent
    19  determines the modification to be in the interests of the people of this
    20  state  or if the superintendent determines that a modification is neces-
    21  sary to maintain insurer solvency. No later than  July  thirty-first  of
    22  each year, every corporation subject to this subparagraph shall annually
    23  report  the actual loss ratio for the previous calendar year in a format
    24  acceptable to the superintendent. If an expected loss ratio is not  met,
    25  the superintendent may direct the corporation to take corrective action,
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11481-01-3

        A. 7852                             2
 
     1  which  may  include  the  submission  of  a rate filing to reduce future
     2  premiums, or to issue dividends, premium  refunds  or  credits,  or  any
     3  combination  of  these. For the purposes of this subsection with respect
     4  to  dental  policy  forms,  "minimum loss ratio" shall mean the required
     5  minimum percentage that dental insurance plans must dedicate for patient
     6  care rather than administrative and  overhead  cost.  If  not  met,  the
     7  difference must be refunded to individuals or group policy owners in the
     8  form of a rebate.
     9    §  2.    Subparagraph  (A) of paragraph 3 of subsection (c) of section
    10  4308 of the insurance law, as amended by section 62 of part D of chapter
    11  56 of the laws of 2013, is amended and a new subparagraph (C)  is  added
    12  to read as follows:
    13    (A)  The  expected  minimum  loss ratio for a contract form subject to
    14  this subsection for which a rate filing or application is made  pursuant
    15  to   this  paragraph,  other  than  a  medicare  supplemental  insurance
    16  contract, but including  a  dental  insurance  contract,  or,  with  the
    17  approval  of  the  superintendent, an aggregation of contract forms that
    18  are combined  into  one  community  rating  experience  pool  and  rated
    19  consistent  with  community  rating requirements, shall not be less than
    20  eighty-two percent. In reviewing  a  rate  filing  or  application,  the
    21  superintendent  may  modify the eighty-two percent expected minimum loss
    22  ratio requirement if the superintendent determines the  modification  to
    23  be in the interests of the people of this state or if the superintendent
    24  determines  that a modification is necessary to maintain insurer solven-
    25  cy. No later than July thirty-first  of  each  year,  every  corporation
    26  subject to this subparagraph shall annually report the actual loss ratio
    27  for the previous calendar year in a format acceptable to the superinten-
    28  dent.  If  an  expected  loss  ratio  is not met, the superintendent may
    29  direct the corporation to take corrective action, which may include  the
    30  submission of a rate filing to reduce future premiums, or to issue divi-
    31  dends, premium refunds or credits, or any combination of these.
    32    (C)  (i)  The  expected  minimum loss ratio for a dental contract form
    33  subject to this subsection for which a rate  filing  or  application  is
    34  made  pursuant  to  this  paragraph,  other than a medicare supplemental
    35  insurance contract, shall  not  be  less  than  eighty-two  percent.  In
    36  reviewing  a  rate  filing or application, the superintendent may modify
    37  the eighty-two percent expected minimum loss ratio  requirement  if  the
    38  superintendent determines the modification to be in the interests of the
    39  people  of this state or if the superintendent determines that a modifi-
    40  cation is necessary to maintain insurer solvency.  No  later  than  July
    41  thirty-first  of  each  year, every corporation subject to this subpara-
    42  graph shall annually report the  actual  loss  ratio  for  the  previous
    43  calendar  year in a format acceptable to the superintendent. The depart-
    44  ment shall make available to the public all data  provided  pursuant  to
    45  this section.
    46    (ii)  If  an  expected  loss  ratio is not met, the superintendent may
    47  direct the corporation to take corrective action, which may include  the
    48  submission of a rate filing to reduce future premiums, or to issue divi-
    49  dends, premium refunds or credits, or any combination of these.
    50    §  3.    This act shall take effect immediately and shall apply to any
    51  policies issued or in effect on and after January 1, 2024.
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