Missouri legislation · 2025 Regular Session
Missouri HB439: Creates provisions relating to dental plans
Status: In committee, May 15, 2025
What the bill says
To amend chapter 354, RSMo, by adding thereto one new section relating to dental plans. Section A. Chapter 354, RSMo, is amended by adding thereto one new section, to be known as section 354.718, to read as follows: 354.718. 1. As used in this section, the following terms mean: (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) The numerator shall be the amount expended for clinical dental services provided to dental plan enrollees.
From the introduced text:
To amend chapter 354, RSMo, by adding thereto one new section relating to dental plans. Section A. Chapter 354, RSMo, is amended by adding thereto one new section, to be known as section 354.718, to read as follows: 354.718. 1. As used in this section, the following terms mean: (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) The 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: a. 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; c. Amounts paid to third-party vendors for network development, administrative fees, claims processing, and utilization management; d. Amounts 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 EXPLANATION -- …