An Act To Require Dental Plan Medical Loss Ratio Reporting and Review
Maine Legislature, Session 130, LD 1266
Committee Amendment CA_A_S438 (Senate)
Amends: 24-A MRSA §4319-B

. COMMITTEEAMENDMENT"A "to S.P. 417, L.D. 1266, "AnActTolmprovethe 
Value of Dental Insurance" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Require Dental Plan Medical Loss Ratio Reporting and Review' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §4319-B is enacted to read: 
§4319-B. Medical loss ratio reporting for dental insurance plans 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Dental plan" means a plan providing dental care services to an enrollee who is 
insured by a carrier. "Dental plan" does not include: 
(l) A health plan with embedded dental benefits offered by a carrier; 
(2) A self-funded employer group health or dental plan, including the group health 
plan or dental plan provided pursuant to Title 5, section 285 if that health plan or 
dental plan is self-funded in any given year; or 
• 
(3) A plan providing dental care services determined by the superintendent to be 
a noncredible plan. 
B. Notwithstanding section4301-A, subsection 5, "enrollee" means an individual who 
is enrolled in an individual or group dental plan. 
2. Dental loss ratio defined. For purposes of this section, the dental loss ratio is the 
ratio of the numerator to the denominator as described in paragraphs A and B, respectively. 
For purposes of this subsection: 
A. The numerator is the sum of: 
COMMITTEE AMENDMENT 
COMMITTEEAMEND!vIBNT" f\-"to S.P. 417, L.D.1266 L S-C\3~ 
Cl) The amount expended for clinical dental services provided to enrollees as 
defined in rule in accordance with subsection 3; 
(2) The amount expended on activities that improve dental care quality as defined 
in rule in accordance with subsection 4; and 
(3) The amount of claims payments identified through fraud reduction efforts; and 
B. The denominator is the total amount of premium revenue, excluding federal and 
state taxes and licensing and regulatory fees paid and after accounting for any payments 
pursuant to federal law. 
The numerator described in paragraph A may not include administrative cost expenditures 
as· defined in rule in accordance with subsection 5. 
3. Expenditures for clinical dental services. 
The superintendent shall define 
"clinical dental services" in rule to be consistent with similar expenditures for clinical 
services used for reporting of medical loss ratio by carriers offering health plans in the 
State. 
4. Activities that improve dental care quality. The superintendent shall define 
"activities that improve dental care quality" in rule to be consistent with similar activities 
related to quality that are permitted for reporting of medical loss ratio by carriers offering 
health plans in this State such as case management; oral health assessments; identifying 
and addressing ethnic, cultural or racial disparities in effectiveness of best clinical practices 
and evidence-based medicine; quality reporting; and health information technology. 
5. Administrative cost expenditures. The superintendent shall define "administrative 
cost expenditures" in rule to be consistent with similar cost expenditures used for reporting 
of medical loss ratio by carriers offering health plans in the State such as financial 
administrative expenses, marketing and sales expenses, commissions, distribution 
expenses, claims operations expenses, utilization review expenses, network operations 
expenses, charitable expenses, board, bureau or association fees and payroll expenses. 
6. Dental loss ratio reporting. Beginning in 2023, on or before July 31st annually, a 
carrier offering a dental plan in effect during the preceding calendar year shall file a report 
with the bureau of the carrier's dental loss ratio for the preceding calendar year organized 
by market segment according to guidance issued by the superintendent. 
A. Within 90 days of receiving any report required under this subsection, the 
superintendent shall post the report on the bureau's publicly accessible website. 
B. If verification of information contained in a report filed under this subsection is 
necessary, the carrier has 30 days to submit any information required by the 
superintendent. 
C. For the initial report filed by a carrier on or before July 31, 2023. the carrier shall 
include dental loss ratio information for calendar years 2020 and 2021 in addition to 
information for calendar year 2022. . 
• 
7. Average dental loss ratio; identifying dental plans with dental loss ratio 
deviating from average. The superintendent shall aggregate the dental loss ratio reports 
filed by each carrier pursuant to subsection 6 by market segment. The superintendent shall 
calculate an average dental loss ratio for each market segment using aggregate data for a 
3-year period, including data for the dental loss ratio reporting year that is being reported 
COMMITTEE AMENDMENT -
COMMITTEE AMENDMENT "A-" to S.P. 417, L.D. 1266(S-lf3tJ) 
arid the data for the 2 prior dental loss ratio reporting years, and identify as outliers dental 
plans that fall outside 2 standard deviations of the average dental loss ratio. If the average 
dental loss ratio in a market segment declines over time, the superintendent may identify 
as outliers dental plans that fall outside one standard deviation of the average dental loss 
ratio or establish by rule a minimum average dental loss ratio for use in calculating outliers. 
8. Authority for review. For those dental plans identified as outliers in accordance 
With subsection 7, the superintendent shall conduct a review and require the carrier of a 
dental plan identified as an outlier to submit additional relevant financial information as 
requested by the superintendent. The superintendent may require the carrier to submit a 
remediation plan including but not limited to measures such as rate revisions or benefit 
modifications. Any action taken by the superintendent pursuant to this subsection is limited 
to. the dental plans identified as outliers. 
9. Rules. The superintendent may adopt rules to implement this section, including 
development of a common reporting form. Rules adopted pursuant to this subsection are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 2. Application. The requirements of this Act apply to all individual and group 
dental plans, as defined in the Maine Revised Statutes, Title 24-A, section 4319-B, 
subsection 1, executed, delivered, issued, continued or renewed in this State. on or after 
January 1, 2023, except for individual and group dental plans issued to a policyholder 
outside of this State. For purposes of this Act, all contracts are deemed to be renewed no 
later than the next yearly anniversary of the contract date.' 
Amend the bill byrelettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill and changes the title. The amendment establishes a 
medical loss ratio reporting requirement for dental plans and requires the publication of 
carrier-specific annual loss· ratio levels on the Department of Professional and Financiai 
Regulation, Bureau of Insurance's publicly accessible website. The amendment also directs 
the bureau to calculate an aggregate average loss ratio by market segment over a 3-year 
period to identify and review dental plans that have loss ratios that deviate from those 
averages. The amendment gives the bureau authority to order the filing of remediation plans 
for identified outliers. 
- The requirements apply to dental plans issued or renewed on or after January 1, 2023 
but do not apply to self-insured plans or to individual or group dental plans for which the 
5 
contract is issued outside of this State. 
FISCAL NOTE REQUIRED 
7 
(See attached) 
• Page 3 - 130LR1479(02) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 03/11/22 feae. 
LD 1266 
LR 1479(02) 
An Act To Improve the Value of Dental Insurance 
Fiscal Note for Bill as Amended by Committee Amendment 'b," (S-<...l3bj 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Additional costs to the Department of Professional and Financial Regulation are expected to be minor and can be 
absorbed within existing budgeted resources. 
LR 147Q(O?) - Fi"r."1 Nnt"' - P<ao-"' 1 "f 1