Kansas SB 182: Requiring the state corporation commission to study certain issues relating to electric utilities.

Bill Text

Session of 2025
SENATE BILL No. 182
By Committee on Financial Institutions and Insurance
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AN ACT concerning health insurance; relating to dental benefit plans and
services; enacting the Kansas medical loss ratios for dental healthcare
services plans act; requiring certain carriers to file a dental loss ratio
annual report; providing for remediation or enforcement actions against
certain carriers that report dental loss ratios that do not meet the
required ratio percentage; authorizing the commissioner to adopt rules
and regulations therefor.
Be it enacted by the Legislature of the State of Kansas:
Section 1. (a) Sections 1 through 4, and amendments thereto, shall be
known and may be cited as the Kansas medical loss ratio for dental
healthcare services plans act.
(b) As used in the Kansas medical loss ratios for dental healthcare
services plans act:
(1) "Commissioner" means the commissioner of insurance;
(2) "dental carrier" or "carrier" means a dental insurance company,
dental service corporation, dental plan organization authorized to provide
dental benefits, or a health benefits plan that includes coverage for dental
services;
(3) "dental healthcare service plan" or "plan" means any plan that
provides coverage for dental health care services to enrollees in exchange
for premiums and does not include plans under Medicaid or CHIP; and
(4) "dental loss ratio" or "DLR" means the percentage of premium
dollars spent on patient care as calculated pursuant to subsection (c).
(c) The dental loss ratio is calculated by dividing the numerator by
the denominator, where:
(1) (A) The numerator is the amount spent on actual patient care
including the total amount expended by the dental benefit plan for clinical
dental services and unpaid claims reserves, less any overpayment
recoveries received by providers and any claim payments recovered by
utilization management; and
(B) the numerator does not include:
(i) Administrative costs, including, but not limited to, infrastructure,
personnel costs or broker payments;
(ii) amounts paid to third-party vendors for secondary network
savings, network development, administrative fees, claims processing or
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SB 182 2
utilization management; or
(iii) amounts paid to providers for professional or administrative
services that do not represent compensation or reimbursement for covered
services provided to an insured, including, but not limited to, dental record
copying costs, attorney fees, subrogation vendor fees, compensation to
paraprofessionals, janitors, quality assistance analysts, administrative
supervisors, secretaries and dental record clerks; and
(2) (A) the denominator is the total amount of earned premium
revenues and is calculated using dental benefit plan revenue;
(B) the denominator does not include:
(i) Federal and state taxes; and
(ii) licensing and regulatory fees paid after accounting for any
payments made pursuant to federal law.
Sec. 2. (a) (1) A carrier that issues, sells, renews or offers a
specialized healthcare service plan shall file a DLR annual report with the
commissioner. The report shall be organized by market and product type
and contain the same information required in the 2013 federal medical loss
ratio annual reporting form, CMS-10418.
(2) The filing shall also report additional data, including the number
of enrollees, the plan cost-sharing and deductible amounts, the annual
maximum coverage limit and the number of enrollees who meet or exceed
the annual coverage limit.
(b) The DLR reporting year shall be for the fiscal year during which
dental coverage is provided by the plan. All terms used in the DLR annual
report mean the same as defined in the federal public health service act, 42
U.S.C. § 300gg-18, part 158, commencing with § 158.101, of title 45 of
the code of federal regulations and § 1367.003.
(c) If data verification of the carrier's representations in the DLR
annual report is deemed necessary, the commissioner shall notify the
carrier and allow 30 days for submission of any required information.
(d) By January 1 of the year after the commissioner receives the
dental loss ratio information collected pursuant to subsection (a), the
commissioner shall make the information, including the aggregate dental
loss ratio and other data reported pursuant to this section, available to the
public in a searchable format on a public website that allows members of
the public to compare dental loss ratios among carriers by plan type by:
(1) Posting the information on the department's website; or
(2) providing the information to the administrator of an all-payer
health claims database. If the commissioner provides the information to
the administrator, the administrator shall make the information available to
the public in a format determined by the commissioner.
(e) The commissioner shall annually report the data collected
pursuant to this section to the legi