An Act To Improve the Value of Dental Insurance
Maine Legislature, Session 130, LD 1266
Committee: Health Coverage, Insurance and Financial Services
Sponsors: SANBORN, CLAXTON, MAXMIN, POULIOT, STEWART, BROOKS, DUNPHY, MADIGAN
Amends: 24-A MRSA §4301-A, 24-A MRSA §4319-B

Legislative Document
No. 1266
S.P. 417
In Senate, March 29, 2021
An Act To Improve the Value of Dental Insurance
Received by the Secretary of the Senate on March 25, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator SANBORN of Cumberland.
Cosponsored by Senators: CLAXTON of Androscoggin, MAXMIN of Lincoln, POULIOT of 
Kennebec, STEWART of Aroostook, Representatives: BROOKS of Lewiston, DUNPHY of 
Old Town, MADIGAN of Waterville.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4301-A, sub-§5, as enacted by PL 1999, c. 742, §3, is 
amended to read:
5.  Enrollee.  "Enrollee" means an individual who is enrolled in a health plan or a 
managed care plan, except that, for purposes of section 4319-B only, "enrollee" means an 
individual who is enrolled in an individual or group dental plan.
Sec. 2.  24-A MRSA §4319-B is enacted to read:
§4319-B.  Medical loss ratio and rebates for dental insurance plans
1.  Dental plan defined.  For purposes of this section, "dental plan" means a plan 
providing dental care services to an enrollee in this State that is offered or administered by 
a carrier.  "Dental plan" does not include a qualified health plan with embedded dental 
benefits offered by a carrier.
2.  Rebates required.  A carrier must provide rebates for individual and group dental 
plans if the medical loss ratio under subsection 3 is less than the minimum medical loss 
ratio under subsection 4.
A.  A carrier must rebate to the enrollee the total amount of premium revenue received 
by the carrier from the enrollee, excluding federal and state taxes and licensing and 
regulatory fees paid and after accounting for any payments pursuant to federal law, 
multiplied by the difference between the minimum medical loss ratio required by 
subsection 4 and the carrier's medical loss ratio as calculated in subsection 3.
B.  A carrier must provide any rebate owed to an enrollee no later than September 30th 
following the end of the previous reporting year.
3.  Medical loss ratio.  For purposes of this section, the medical 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 amount expended on reimbursement for clinical dental 
services provided to enrollees and activities that improve dental care quality as defined 
in rules and in accordance with subsection 5; 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.
4.  Minimum medical loss ratio.  The minimum medical loss ratio is 80%.
5.  Activities that improve dental quality.  Activities that improve dental quality must 
be defined in rule and aligned with similar activities related to quality that are permitted 
for the determination of the medical loss ratio by carriers offering health plans in this State.  
Activities that improve dental quality may not include activities that are focused primarily 
on cost containment, related to the management of claims adjudication systems or 
retrospective or concurrent utilization review, or related to the development of provider 
networks, negotiating provider contracts or credentialing providers.
6.  Rules.  The superintendent may adopt rules to implement this section.  Rules 
adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 
375, subchapter 2‑A.
7.  Reports.  Beginning July 1, 2023 and on or before July 1st annually thereafter, a 
carrier offering an individual or group dental plan shall report medical loss ratio 
information for the preceding calendar year in the format and manner determined by the 
superintendent. Within 45 days of receiving reports required under this subsection, the 
superintendent shall post the reports on its publicly accessible website. If verification of 
information contained in a report filed under this subsection is necessary, the 
superintendent shall provide at least 30 days' prior notice to the carrier providing the dental 
plan before commencing any examination, and the carrier has 30 days to submit any 
information required by the superintendent.
8.  Exemption.  This section applies to the group health plan provided pursuant to Title 
5, section 285.
Sec. 3.  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 for delivery, continued or renewed in this State 
on or after January 1, 2022. For purposes of this Act, all contracts are deemed to be renewed 
no later than the next yearly anniversary of the contract date.
SUMMARY
This bill establishes a minimum medical loss ratio of 80% for dental plans and requires 
rebates to be provided in any year in which a dental plan's medical loss ratio is less than 
the minimum. The bill's requirements apply to dental plans issued or renewed on or after 
January 1, 2022.