S T A T E O F N E W Y O R K
________________________________________________________________________
3919
2025-2026 Regular Sessions
I N A S S E M B L Y
January 30, 2025
___________
Introduced by M. of A. WEPRIN, HEVESI, TAYLOR, PAULIN, BROOK-KRASNY --
read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to establishing a medical
loss ratio for dental insurance
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 3 of subsection (e) of section 3231 of the
insurance law, as added by chapter 107 of the laws of 2010, is amended
to read as follows:
(3) (A) All policy forms subject to this subsection, other than medi-
care supplemental insurance policy forms, BUT INCLUDING POLICY FORMS
COVERING ANY DENTAL SERVICES WHERE A PREMIUM IS COLLECTED, issued or in
effect during calendar year two thousand ten shall be subject to a mini-
mum loss ratio requirement of eighty-two percent. Insurers may use the
alternate filing procedure set forth in paragraph two of this subsection
to adjust premium rates in order to meet the required minimum loss ratio
for calendar year two thousand ten. The rate filing or application shall
be submitted no later than September thirtieth, two thousand ten.
(B) THE EXPECTED MINIMUM LOSS RATIO FOR A DENTAL POLICY FORM SUBJECT
TO THIS SUBSECTION ISSUED OR IN EFFECT DURING AND AFTER CALENDAR YEAR
TWO THOUSAND TWENTY-SIX, OTHER THAN A MEDICARE SUPPLEMENTAL INSURANCE
CONTRACT, SHALL NOT BE LESS THAN EIGHTY-TWO PERCENT. IN REVIEWING A RATE
FILING OR APPLICATION, THE SUPERINTENDENT MAY MODIFY THE EIGHTY-TWO
PERCENT EXPECTED MINIMUM LOSS RATIO REQUIREMENT IF THE SUPERINTENDENT
DETERMINES THE MODIFICATION TO BE IN THE INTERESTS OF THE PEOPLE OF THIS
STATE OR IF THE SUPERINTENDENT DETERMINES THAT A MODIFICATION IS NECES-
SARY TO MAINTAIN INSURER SOLVENCY. NO LATER THAN JULY THIRTY-FIRST OF
EACH YEAR, EVERY CORPORATION SUBJECT TO THIS SUBPARAGRAPH SHALL ANNUALLY
REPORT THE ACTUAL LOSS RATIO FOR THE PREVIOUS CALENDAR YEAR IN A FORMAT
ACCEPTABLE TO THE SUPERINTENDENT. IF AN EXPECTED LOSS RATIO IS NOT MET,
THE SUPERINTENDENT MAY DIRECT THE CORPORATION TO TAKE CORRECTIVE ACTION,
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07555-01-5
A. 3919 2
WHICH MAY INCLUDE THE SUBMISSION OF A RATE FILING TO REDUCE FUTURE
PREMIUMS, OR TO ISSUE DIVIDENDS, PREMIUM REFUNDS OR CREDITS, OR ANY
COMBINATION OF THESE. FOR THE PURPOSES OF THIS SUBSECTION WITH RESPECT
TO DENTAL POLICY FORMS, "MINIMUM LOSS RATIO" SHALL MEAN THE REQUIRED
MINIMUM PERCENTAGE THAT DENTAL INSURANCE PLANS MUST DEDICATE FOR PATIENT
CARE RATHER THAN ADMINISTRATIVE AND OVERHEAD COST. IF NOT MET, THE
DIFFERENCE MUST BE REFUNDED TO INDIVIDUALS OR GROUP POLICY OWNERS IN THE
FORM OF A REBATE.
§ 2. Subparagraph (A) of paragraph 3 of subsection (c) of section
4308 of the insurance law, as amended by section 62 of part D of chapter
56 of the laws of 2013, is amended and a new subparagraph (C) is added
to read as follows:
(A) The expected minimum loss ratio for a contract form subject to
this subsection for which a rate filing or application is made pursuant
to this paragraph, other than a medicare supplemental insurance
contract, BUT INCLUDING A DENTAL INSURANCE CONTRACT, or, with the
approval of the superintendent, an aggregation of contract forms that
are combined into one community rating experience pool and rated
consistent with community rating requirements, shall not be less than
eighty-two percent. In reviewing a rate filing or application, the
superintendent may modify the eighty-two percent expected minimum loss
ratio requirement if the superintendent determines the modification to
be in the interests of the people of this state or if the superintendent
determines that a modification is necessary to maintain insurer solven-
cy. No later than July thirty-first of each year, every corporation
subject to this subparagraph shall annually report the actual loss ratio
for the previous calendar year in a format acceptable to the superinten-
dent. If an expected loss ratio is not met, the superintendent may
direct the corporation to take corrective action, which may include the
submission of a rate filing to reduce future premiums, or to issue divi-
dends, premium refunds or credits, or any combination of these.
(C) (I) THE EXPECTED MINIMUM LOSS RATIO FOR A DENTAL CONTRACT FORM
SUBJECT TO THIS SUBSECTION FOR WHICH A RATE FILING OR APPLICATION IS
MADE PURSUANT TO THIS PARAGRAPH, OTHER THAN A MEDICARE SUPPLEMENTAL
INSURANCE CONTRACT, SHALL NOT BE LESS THAN EIGHTY-TWO PERCENT. IN
REVIEWING A RATE FILING OR APPLICATION, THE SUPERINTENDENT MAY MODIFY
THE EIGHTY-TWO PERCENT EXPECTED MINIMUM LOSS RATIO REQUIREMENT IF THE
SUPERINTENDENT DETERMINES THE MODIFICATION TO BE IN THE INTERESTS OF THE
PEOPLE OF THIS STATE OR IF THE SUPERINTENDENT DETERMINES THAT A MODIFI-
CATION IS NECESSARY TO MAINTAIN INSURER SOLVENCY. NO LATER THAN JULY
THIRTY-FIRST OF EACH YEAR, EVERY CORPORATION SUBJECT TO THIS SUBPARA-
GRAPH SHALL ANNUALLY REPORT THE ACTUAL LOSS RATIO FOR THE PREVIOUS
CALENDAR YEAR IN A FORMAT ACCEPTABLE TO THE SUPERINTENDENT. THE DEPART-
MENT SHALL MAKE AVAILABLE TO THE PUBLIC ALL DATA PROVIDED PURSUANT TO
THIS SECTION.
(II) IF AN EXPECTED LOSS RATIO IS NOT MET, THE SUPERINTENDENT MAY
DIRECT THE CORPORATION TO TAKE CORRECTIVE ACTION, WHICH MAY INCLUDE THE
SUBMISSION OF A RATE FILING TO REDUCE FUTURE PREMIUMS, OR TO ISSUE DIVI-
DENDS, PREMIUM REFUNDS OR CREDITS, OR ANY COMBINATION OF THESE.
§ 3. This act shall take effect immediately and shall apply to any
policies issued or in effect on and after January 1, 2026.