                                 CODE OF VIRGINIA

DENTAL CARRIERS; ANNUAL ACTUAL LOSS RATIO REPORT (§ 38.2-316.2)

A. As used in this section:
			&#8220;Actual loss ratio&#8221; means, for large employer coverage issued by
a dental carrier, the ratio of incurred claims and other compensation paid or
due to dental providers for the reporting period to earned premiums for dental
services provided under a dental carrier contract issued in the Commonwealth,
excluding, for the reporting period, (i) related state and federal taxes; (ii)
related licensing and regulatory fee expenses; (iii) nonprofit community benefit
expenditures, which have been disclosed to the public, to support dental
services and improve dental care access and quality in the Commonwealth; (iv)
the amounts or related claims payments identified through fraud reduction
efforts; and (v) any other related payments required under state or federal law.
			&#8220;Dental carrier&#8221; means (i) any carrier, as defined in &#xA7;
38.2-3407.15, that offers separate or specific dental policies to large
employers; (ii) any nonstock corporation that offers or administers dental
services plans, as defined in &#xA7; 38.2-4501, to large employers; or (iii) a
dental plan organization, as defined in &#xA7; 38.2-6101, that provides coverage
to large employers.
			&#8220;Large employer&#8221; means, with respect to a calendar year and a
plan year, an employer who employed an average of at least 51 employees on
business days during the preceding calendar year and who employs at least one
employee on the first day of the plan year.

B. Beginning in 2025, each dental carrier shall annually, on or before April 30,
file with the Commission a report that includes the actual loss ratio for the
preceding calendar year and any such other information as the Commission may
require. A dental carrier shall file such report in accordance with the format
or forms prescribed by the Commission.

C. The Commission shall annually post such reports on a dedicated link or page
on the Commission&#8217;s website on or before June 15 after receipt of such
reports.

HISTORY: 2024, cc. 319, 345.