Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 156.00 - Dental Insurance › Section 156.06 - Submission and Review of Rate Filings

Current through Register 1525, July 5, 2024
(1)
Definitions
. For rate filings submitted pursuant to
			 211
			 CMR 156.06(2), the following
			 definitions also shall apply:
(a)
Capital Costs and Depreciation Expenses
. All expenses
			 associated with depreciation (depreciation for electronic data processing,
			 equipment, software, and occupancy); capital acquisitions (acquisition of
			 capital assets, including lease payments that were paid or incurred during the
			 year); capital costs on behalf of a clinic (expenditures for capital and lease
			 payments incurred or paid during the year on behalf of a clinic; or part of a
			 partnership, joint venture, integration, or affiliation agreement); and other
			 capital (other costs that are directly associated with the incurring of capital
			 costs, such as legal or administrative costs, incurred or paid during the
			 year).
(b)
Charitable
			 Contributions Expenses
. All contributions to tax-exempt
			 foundations and charities, not related to the company business
			 enterprises.
(c)
Claim
			 Completion Method
. Any actuarial method used to quantify Claims
			 which have been incurred but not yet paid.
(d)
Claims Operations
			 Expenses
. All expenses associated with Claims adjudication and
			 adjustment of Claims, appeals, Claims settlement, coordination of benefits
			 processing, maintenance of the Claims system, printing of Claims forms, Claim
			 audit function, electronic data interchange expenses associated with Claims
			 processing, and fraud investigation.
(e)
Distribution
			 Expenses
. All expenses associated with distribution and sale of
			 dental products, including commissions, producer, broker and benefit consultant
			 fees, other fees, commission processing, and account reporting to brokers,
			 agents, and producers.
(f)
Financial Administration Expenses
. All expenses
			 associated with underwriting, auditing, actuarial, financial analysis,
			 investment-related expenses (not included elsewhere), treasury, and
			 reinsurance.
(g)
General Administration Expenses
. All expenses
			 associated with payroll administration expenses and payroll taxes (salaries,
			 benefits and payroll taxes); real estate expenses (company building and other
			 taxes and expenses of owned real estate, excluding home office employee
			 expenses and rent [not allocated elsewhere] and insurance on real estate);
			 regulatory compliance and government relations (federal and state reporting,
			 rate filing, state and federal audits, tax accounting, lobbying, licensing and
			 filing fees, preparation and filing of financial, utilization, statistical and
			 quality reports, and administration of government programs); board, bureau, or
			 association fees (Board of Directors, Bureau and association fees paid or
			 expensed during the calendar year); other administration (information
			 technology, senior management, outsourcing [not allocated elsewhere], insurance
			 except on real estate, equipment rental, travel [not allocated elsewhere],
			 certification and accreditation fees, legal fees and expenses before
			 administrative and legal bodies, and other general administrative expenses);
			 and negative adjustment for reimbursement from uninsured plans (all revenue
			 receipts from uninsured plans [including excess pharmaceutical rebates and
			 administrative fees net of expenses] and reimbursements from fiscal
			 intermediaries, including administrative fees net of expenses from the
			 government).
(h)
Marketing and Sales Expenses
. All expenses associated
			 with billing and Member enrollment (group and individual billing, Member
			 enrollment, premium collection, and reconciliation functions); customer service
			 and Member relations (individual, group or provider support relating to
			 membership, enrollment, grievance resolution, specialized phone services and
			 equipment, consumer services, and consumer information); product management,
			 marketing and sales (management and marketing of current products, including
			 product promotion and advertising, marketing materials, changes or additions to
			 current products, sales, pricing, and enrollee education regarding coverage
			 prior to the sale); and product development: (product design and development
			 for new products not currently offered, major systems development associated
			 with the new products, and integrated system network development).
(i)
Dental Administration
			 Expenses
. All expenses associated with quality assurance and cost
			 containment (dental and disease management and wellness initiatives other than
			 for education), Dental Care quality assurance, appeals, case management, fraud
			 detection and prevention, utilization review, practice protocol development,
			 peer review, outcomes analysis related to existing products, nurse triage,
			 dental management, and other Dental Care evaluation activities; wellness and
			 dental education (wellness and dental promotion, disease prevention, Member
			 education and materials, and outreach services); and dental research (outcomes
			 research, dental research programs, and development of new dental management
			 programs not currently offered, major systems development, and integrated
			 system network development).
(j)
Miscellaneous Expenditures Expenses
. All other
			 expenses that are not classified expenses, including all collection and bank
			 service charges, printing, office supplies, postage, and telephone (not
			 allocated elsewhere).
(k)
Network Operations Expenses
. All expenses associated
			 with provider contracting negotiation and preparation, monitoring of provider
			 compliance, field training with providers, provider communication materials and
			 bulletins, administration of provider capitation and settlements, dentist
			 relations, dental policy procedures, network access fees, and
			 credentialing.
(l)
Taxes, Assessments and Fines Paid to Federal, State or Local
			 Governments (as Expenses)
. All expenses associated with taxes
			 (including, but not limited to, state premium taxes, state and local insurance
			 taxes, federal taxes, except taxes on capital gains, state income tax, state
			 sales tax, and other sales taxes not included with the cost of goods
			 purchased); assessments, fees and other amounts paid to regulatory agencies
			 (assessments, fees, or other amounts paid to state or local government, but
			 does not include taxes or fines or penalties paid to any government agency);
			 and fines and penalties paid to regulatory agencies (penalties and fines paid
			 to government agencies).