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Medical Loss Ratio

MLRs set requirements on what portion of a customer’s premium must be spent on oral health care. Without MLR requirements, dental insurers in Massachusetts are free to spend patient premiums on the company’s operating, marketing, and administrative activities.


The Ballot Initiative

For years, the MDS has worked to reform MLRs legislatively. While we continue to work with lawmakers and dental insurance providers to find common ground, we’re also realistic that the November 2022 ballot measure is finally a chance to achieve the necessary change.

The referendum would:

  • Set the MLR for dental plans at 83%, requiring insurers to refund any excess premium to customers
  • Require dental benefit providers to disclose projected medical loss ratio for plans, file the following year’s group product base rates by July, and release other specified financial information
  • Authorize the Commissioner of the Massachusetts Division of Insurance to approve or disapprove of any product rates 

Note: An Act Relative to Transparency of Dental Benefits Corporations was sent to study in the 2021-2022 legislative session. This led the MDS Board of Trustees to support the MLR ballot initiative.


The Issue

Massachusetts fails to hold dental benefits companies to the same standards as general health insurers in ways that are costly and unfair to patients: 

  • The Division of Insurance (DOI) has no power to regulate dental benefit companies' reimbursement fees, regardless of the impact on patients and providers. 
  • While all other health benefits providers must by law spend 88% of premium dollars on patient care, dental benefits companies are free to raise rates without directing any of the increases to actual patient spending. 

FAQs

1. What is the MDS’ position on the measure likely to be on the ballot during the 2022 elections? Why did the MDS take this position?

  • As an advocate for both regular and affordable dental care for all Massachusetts residents, The Massachusetts Dental Society endorses the Massachusetts Medical Loss Ratios for Dental Insurance Plans Initiative and encourages voters to pass it. Patient dollars should be required to be spent in support of their oral health, and patients deserve visibility into how much of their dental insurance premiums are paying for care as opposed to administrative costs.
  • The MDS remains committed to MLR reform here in the Commonwealth to ensure that dental benefits companies are transparent and accountable to the people they serve.
  • The MDS is a professional association representing 5,000-plus member dentists and a statewide constituent of the American Dental Association. It is dedicated to the professional development of its member dentists through initiatives in education, advocacy, the promotion of the highest professional standards, and championing oral health in the Commonwealth.

2. What is the current status of the ballot measure?

  • The referendum is being challenged in court – arguments have been heard and the Supreme Judicial Court will make a ruling over the coming months.
  • While not a formal part of the process, this is a typical hurdle that most ballot measures face before officially being placed on the ballot to be decided upon by voters.

3. Is the MDS affiliated or otherwise working with the Committee on Dental Insurance Quality in support of the likely ballot measure?

  • No, the MDS is supporting the ballot measure in its capacity as an independent organization and is not active in any activities of the Committee on Dental Insurance Quality.

4. How would establishing a MLR for dental insurers impact the practice of dentistry in the Commonwealth? Oral health outcomes for patients? Would this reduce access to care?

  • Patient dollars should be required to be spent in support of their oral health, and patients deserve visibility into how much of their dental insurance premiums are paying for care as opposed to administrative costs.
  • Patients deserve predictability and support in seeking out dental treatment in their communities and all Massachusetts residents deserve access to quality oral health services that are essential to maintaining overall health.
  • The MDS is continually working with civic leaders to advocate for and advance policies that both expand peoples’ access to care and protect the quality of care patients receive.

5. What do the provisions of the likely ballot measure say?

  • Set the medical loss ratio for dental plans at 83%, requiring insurers to refund any excess premium to customers
  • Require dental benefit providers to disclose projected medical loss ratio for plans, file the following year’s group product base rates by July, and release other specified financial information
  • The Commissioner of the Massachusetts Division of Insurance would be authorized to approve or disapprove of any product rates