Dear Health Insurance & Long-Term Care Issues Committee Members:
On behalf of the undersigned members of the Organized Dentistry Coalition, we urge you toadopt the Medical Loss Ratios (MLR) for Dental Health Care Services Plans Model Act (theModel Act). The Model Act, sponsored by Del. Steve Westfall (WV), will be presented to theHealth Insurance & Long-Term Care Issues Committee for further consideration on July 20,
2023. Medical Loss Ratio laws serve to maximize patients’ investments in their health carecoverage plans. Adopting this act will help dental patients receive greater value from theirdental insurance products and therefore, improved access to dental care.
Medical Loss Ratio is a simple measure of the percentage of insurers’ revenue spent on actualcare. Measuring insurers’ investment in care is not a new concept, but in recent years there has
been an increasing concern about insurance products’ lack of transparency and whether they
provide true value for patients. On the major medical side, lawmakers have acted upon thisconcern using MLR data to better ensure health care value for patients. Medical plans in allstates are now required to spend 80-85% of their premium revenue on actual care or refund topatients an amount that would equate to reaching this percentage. Dental Insurers have claimed
that negative results will occur if MLR is implemented, but analysis of the major medical
argument rebuts that claim. According to a May 2015 report from the Robert Wood Johnson
Foundation/Urban Institute, MLR changed the behavior of low-MLR plans: “The MLR ruleappears to have prompted significant increases in claims payouts among insurers with lowMLRs in 2010.”1 Health insurers are being held accountable for the products they market.
Dental insurers with low-MLRs can be anticipated to increase the value of their plans forconsumers by paying out more for claims, just as the health plans did.
In order to effectively promote and establish accountability and improve patient access to care,
the Model Act must include four components:
 Comprehensive definitions that ensure all dental insurers are included and clearly define
how MLR will be calculated.
 Transparency that allows both regulators and the public to see accurate informationabout insurers’ MLR.
 Minimum MLR standard, with refunds for subscribers if the standard is not met.
 Rate Review and Approval allowing state insurance authorities to block excessive andunreasonable rate increases.
These policies will maximize the care available to patients within their dental plans by requiring
dental insurers to be more transparent in their operations and spend the majority of patient
premiums on patient dental care — just as medical insurers already do. Dental insurers are also
claiming that having transparency alone is enough for consumers, but analysis of data from
California, which has had a MLR reporting-only law since 2014, the average MLR of plans in thestate has remained unchanged. In short, consumers have not yet reaped any benefit.
While dental insurance was not included in the national MLR reforms in 2010, dental patientsdeserve the same protections, and clearly want them. In November 2022, Massachusetts votersapproved a standard-setting MLR ballot question by a substantial, bipartisan, 72 percent.
Adopting the Model Act at NCOIL would be one of the first steps to ensure dental patients
across the country enjoy the same protections as found under medical insurance MLR
guidelines. Leading health care thinktanks on both sides of the aisle agree. The Consumer
1 https://www.urban.org/sites/default/files/publication/52726/2000222-Health-Insurer-Responses-to-

Medical-Loss-Ratio-Regulation-Increased-Efficiency-and-Value-to-Consumers.pdf

Choice Center, a right-leaning organization, suggested that adding a requirement for a medical
loss ratio for dental insurers would help promote price transparency and provide incentives toreduce administrative waste. This would help reduce costs for patients.2 Similarly, theProgressive Policy Institute says dental plans should be subject to greater regulation to ensurethat consumers’ and employers’ premium dollars are going toward actual dental care. 3Adopting the Model Act would serve to promote accountability among dental insurers. We urge
NCOIL to take the lead in promoting the same accountability that has existed for over a decadefor health plans and adopt the Model Act. On behalf of our members and their patients, wethank you for your consideration. Please contact Chad Olson at 312-440-3520/olsonc@ada.org
with any questions.
Sincerely,
American Dental Association
Academy of General Dentistry
American Academy of Pediatric Dentistry
American Academy of Periodontology
American Association of Endodontists
American Association of Oral and Maxillofacial Surgeons
American Association of Orthodontists
American College of Prosthodontists
American Society of Dentist Anesthesiologists
American Student Dental Association

2 Dental Insurance Reform 2021 Policy Note
3 Dental insurance: Plans without protections