HB 2471 — DENTAL PLANS

Summary

Creates provisions relating to dental plans

Bill Text

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends 1 section(s) of the Missouri Revised Statutes: Section 354.718, RSMo.

• Section 354.718, RSMo

  (1) "Dental loss ratio", the percentage of the amount of premiums received by a dental plan expended on actual patient care rather than overhead or administrative costs, as determined by the following fraction: (a)e numerator shall be the amount expended for clinical dental services provided to dental plan enrollees, including payments under capitation contracts with dental providers, during the reporting year together with unpaid claim reserves for dental services performed during the reporting year but not yet paid. The numerator shall not include: Administrative costs including, but not limited to, infrastructure costs, personnel costs, or broker payments; b. Amounts paid to third-party vendors for secondary network savings; cAmounts paid to third-party vendors for network development, administrative fees, claims processing, and utilization management; d.unts paid to providers for professional or administrative services that do not represent compensation or reimbursement for covered services provided to an enrollee including, but not limited to, dental record copying costs, attorney's fees, subrogation vendor fees, and compensation to paraprofessionals, janitors, quality bold-face assurance analysts, administrative supervisors, secretaries to dental personnel, and dental record clerks; or e.payments made by the provider that were recovered by the dental plan and not previously reported on any dental loss ratio report; and (b) denominator shall be all earned premiums received by the dental plan for dental services, excluding federal and state taxes; licensing fees; regulatory fees; payments or receipts for risk adjustment, risk corridors, and reinsurance; community benefit expenditures, as defined in 45 CFR 158.162(c); and any other payments required by federal law; (2)ntal plan", any health benefit plan, or portion of a health benefit plan, that issues, sells, renews, or offers a contract covering dental care services. The term "dental plan" shall not include any health benefit plan for health care services under MO HealthNet, the state children's health insurance program authorized in sections 208.631 to 208.658, or any other state-sponsored health insurance program. 2.A dental plan shall file with the department of commerce and insurance a dental loss ratio report for each calendar year during which the dental plan provided dental coverage containing the same information as required in the 2013 federal dental loss ratio annual reporting form (CMS-10418). All terms used in the dental loss ratio annual report shall have the same meanings as used in the federal Public Health Service Act, 42 U.S.C. Section 300gg-18, and 45 CFR Part 158. (2) The dental loss ratio report shall be filed before March first of each year for the previous calendar year. If the department of commerce and insurance requires data verification of the dental loss ratio report, it shall give the dental plan thirty days' notice of the additional information and data required to be submitted to the department. The dental plan shall submit the information requested within thirty days of such notice. The department shall be deemed to have approved all dental loss ratio reports within ninety days of the filing of the reports unless a dental plan is notified otherwise. (3) department of commerce and insurance shall make available to the public all the data provided to the department in accordance with this section. 3. A dental plan shall provide an annual rebate to each enrollee, on a pro rata basis, to the extent the dental loss ratio is less than eighty-five percent before August first of the year following the year for which the dental loss ratio report was issued. The total annual rebate is the excess revenue expended by the dental plan on overhead or administrative costs, as determined by the amount by which the denominator of the dental loss ratio exceeds the numerator. 4. Any failure to rebate the amount prescribed in subsection 3 of this section by a de

  amended

Action History

1. May 15, 2026

   Referred: Emerging Issues(H)

2. January 08, 2026

   Read Second Time (H)

3. January 07, 2026

   Read First Time (H)

4. December 16, 2025

   Prefiled (H)

Sponsors

• Jeff Farnan · Primary

Subjects