Larger dental insurers must refund excess premiums starting July 2027

Covered dental insurers will have to return excess premiums when a plan’s annual patient care spending ratio falls below 75%. The rule covers insurers averaging more than 1,000 enrollees across all their plans over three years. The insurance commissioner may reduce or waive refunds only if issuing them would threaten the insurer’s financial health. Insurers must notify covered people and groups about refunds or, for those still covered, credits toward the following twelve months of premiums. Total refunds must bring the plan’s patient care spending ratio to 75%, using the law’s calculation. The refund rules take effect July 1, 2027.

The insurance commissioner will be allowed to reject a proposed dental plan rate as excessive when an insurer files a rate change and meets any listed trigger. The rule covers insurers averaging more than 1,000 enrollees across all their plans over three years. One trigger is an administrative expense increase of more than 4% from the previous year’s rate filing, excluding taxes and assessments. The other triggers are money added to financial reserves above 2% of total revenue or a patient care spending ratio below 75%. The rate review rules take effect July 1, 2027.

Dental insurers must report their patient care spending ratios, and the insurance commissioner must publish the information online. Reporting covers insurers that issue, sell, renew, or offer specialized dental health care plans, including small insurers. Reports must separate information by market and product type. Insurers must provide information verifying their reports within 30 days of the commissioner’s request. Reports are due April 30 each year and cover the previous calendar year.