Medical Loss Ratio
- Spend at least 83% of premium dollars on patient care,
- Report to the state Division of Insurance that they meet that percentage
- Refund the difference back to customers if they don’t meet the percentage
On November 2nd and in accordance with the process set forth by the Division of Insurance (DOI) the Massachusetts Dental Society submitted a formal response to the draft regulations for Dental Benefit Plans, 211 CMR 156. These are the regulations that will be put into effect on January 1, 2024 by the DOI following the resounding victory of Question #2 in the Fall of 2022.
The ballot question proposed:
- Set the MLR for dental plans at 83%, requiring insurers to refund any excess premium to customers
- Required dental benefit providers to disclose projected medical loss ratio for plans, file group product base rates yearly, and release other specified financial information
- Authorized the Commissioner of the Massachusetts Division of Insurance to approve or disapprove of any product rates
Learn more about the ballot question details here.
The MDS and American Dental Association (ADA) worked together to create the Massachusetts Dental Care Providers for Better Dental Benefits Committee. The Committee informed and engaged voters on the campaign message of "Voting Yes on Question 2" by developing a website, promotional materials, advertising, and other methods of communication to inform Massachusetts voters on the issue. Grassroots efforts by MDS members reaching out to voters also aided in the victory.
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.
- Section 1: Definitions, including dental loss ratios—held on January 18, 2023
- Section 2(a) – (c): Rate filing submissions and rebate calculation submissions—held on February 1, 2023
- Section 2(d) – (g): Rate filing reviews—help on February 15, 2023
- Section 3: Reporting annual comprehensive financial—help on March 1, 2023
- Additional Questions/Wrap-Up—held on March 15, 2023
The DOI will draft regulations based on the comments from the listening sessions and any feedback they solicit independently (e.g., they could get an independent report from an actuary). Those will be released and allow for public comments, often through a public meeting where people can offer their comments live. The DOI will consider the public comments as they finalize the regulations. The final regulations will then be released and implemented as law on January 1, 2024. The MDS will continue to monitor the regulatory process to ensure that the law is closely aligned with the intent of the ballot initiative that Massachusetts residents overwhelmingly supported in the November 2023 Massachusetts election.