What is Dental Insurance and Which Companies Offer Dental Insurance in Massachusetts?
Dental insurance pays for the cost of covered dental treatment according to the terms of the coverage. Most traditional health coverage does not include coverage for dental services; instead, insurance companies offer dental-specific insurance policies that are separate (“stand-alone”) from traditional health insurance. Such stand-alone products are not subject to health insurance regulations, but they are now subject to the requirements of the new law specific to dental insurance.
Additional Resources
How is Dental Insurance Regulated?
The DOI is responsible for the licensure and financial review of all licensed insurance companies, Blue Cross and Blue Shield of Massachusetts, Inc., and Delta Dental of Massachusetts (“Carriers”) as well as investigating complaints about dental insurance coverage, scheduling financial and market conduct examinations, and ensuring Carriers comply with regulatory standards, including those regarding the disclosure of plan benefits. The DOI does not oversee providers, including dentists or other dental practitioners.
Massachusetts' new law about dental insurance created standards relative to dental loss ratios and the percentage of premium insurance carriers issuing standalone dental benefit plans are required to spend on patient care. The DOI has developed the following FAQs answer the most commonly asked questions about dental insurance.
What was accomplished when Ballot Initiative 2, Regulation of Dental Insurance, was passed?
The Ballot Initiative resulted in the creation of M.G.L. c. 176X, “Dental Benefit Plans”(the “Statute”). The new Statute created first in the nation standards and requires that dental Carriers satisfy a statutory standard Dental Loss Ratio (DLR) – the proportion of dental claims paid in relation to premiums collected - of 83%. Under the Statute, the DOI was required to promulgate regulations, which apply to all Carriers about how to comply with this new law, including the following:
- how to file form and rate filing materials,
- how to calculate whether Carriers satisfy the statutory Dental Loss Ratio (DLR) standard of 83%,
- how to process rebates when dental Carriers fall below the DLR standard of 83%, and
- how to submit detailed financial reports on an annual basis.
What has been done to implement the Statute?
Following the Ballot Initiative being passed into law, the DOI held a series of public information/listening sessions for interested parties (Carriers, providers, consumers, etc.) to help inform the development of the regulation. The DOI also requested input about guidance that would clarify how materials would be submitted to the DOI to be reviewed for compliance with the Statute.
The DOI developed a draft regulation – 211 CMR 156.00 – and held a public hearing to receive comments on the proposed regulation. All oral and written comments were reviewed, and appropriate revisions to the draft regulation were considered in advance of the regulation’s official promulgation. As this is the first regulation of its kind in the nation, the DOI carefully considered all submitted comments to establish clear rules that foster a healthy and affordable market for insured stand-alone dental coverage.
The regulation has been finalized (see 211 CMR 156 below). In addition to developing the regulation, the DOI is preparing filing guidance notices, rate filing templates and other tools needed to ensure compliance with the Statute, as well as information intended for consumers and dental providers to further explain the law and the new regulation in order to minimize any confusion.
APPLICABILITY
Does the Statute apply to all dental plans?
The Statute applies to all fully insured stand-alone dental benefit plans issued to individuals, group associations, and employers in Massachusetts, including dental plans issued through the Massachusetts Health Connector.
The Statute does not apply to dental plans that are issued outside of Massachusetts or through government programs (e.g., Medicaid, known as MassHealth, and plans offered through the Group Insurance Commission). In addition, many large employers self-fund employee dental benefits, meaning that they pay the dental benefits from their own resources rather than buying an insured dental plan from a dental Carrier. These self-funded dental plans are exempt from state insurance laws, including those identified within the Statute.
How can someone know if their dental plan is subject to the Statute?
Individuals should contact their employer’s human resources representative or their dental Carrier to understand whether they are in a Massachusetts-issued insured stand-alone dental plan that is subject to the protections of the Statute. In order to understand if the Statute applies, ask “Is my dental plan fully insured and subject to Massachusetts state insurance laws, or is it self-funded?”
Will the implementation of the Statute impact access to dental coverage?
Approximately 20 Carriers currently offer stand-alone dental coverage in Massachusetts, and it is possible that some of these companies will restrict their offering of dental coverage in the future as a result of this new law. The Division will be posting information on its website to help consumers be informed about the markets in which Carriers issue and renew coverage.
The DOI does not have authority to require that any Carrier offer coverage in Massachusetts but has taken care when establishing these new rules to create a framework that is consistent with the requirements of M.G.L. c. 176X and promotes continued access to insured dental coverage. The new rules will not impact any dental coverage that has gone into effect or will go into effect in 2024. The rules will impact dental premiums issued or renewed in Massachusetts during 2025. The DOI will work with Carriers to help them to submit required materials and will take steps to standardize review processes so that insured dental plans compliant with M.G.L. c. 176X will be available for 2025.
STATUTORY REQUIREMENTS
What is now required of Carriers under the Statute?
Carriers are required to submit the following to the DOI:
- Form and rate filings are to be submitted annually beginning July 1, 2024 for all insured individual, group association, and employer group dental benefit plans that are issued or renewed in Massachusetts in the following calendar year. This means the forms, including the insurance policy, used by the company and the rates that they will charge beginning in 2025 will be required to meet all statutory standards.
- The rate filings will be disapproved for any of the following reasons:
- the projected administrative expenses increase by more than the consumer price index for dental services (U.S. city average, all urban consumers, not seasonally adjusted);
- the projected contribution-to-surplus is more than 1.9%; or
- the projected DLR is less than 83%.
The rate filings may also be disapproved if the DOI finds that the dental benefits are unreasonable in relation to the rates charged, or if the rates are excessive, inadequate, or unfairly discriminatory.
- Forms to calculate rebates to insured individual, group association, and employer group dental benefit plans are to be submitted annually beginning with Carriers’ 2025 experience. Rebates will be issued to individuals and groups when prior dental experience does not satisfy the statutory DLR[1] of 83%.
- Annual reports identifying detailed financial information about the Carrier’s insured dental business are to be submitted annually beginning with Carriers’ 2025 experience. These reports will present detailed financial information about each Carrier’s insured dental business with information presented by product type and size of the covered group.
If you have additional questions about how your dental coverage may be impacted by the new law, you can contact Kevin Beagan, Deputy Commissioner, Massachusetts Division of Insurance at kevin.beagan@mass.gov.
[1] The DLR is calculated by dividing the combination of incurred dental claims plus certain qualified quality improvement activities by the combination of earned premium and federal and state taxes, assessments, and licensing or regulatory fees.
Dental Insurance Regulation
Past Dental Insurance Information Sessions
DOI held several public listening sessions between January and March of 2023 and published feedback received online: Information Sessions on Chapter 287 of the Acts of 2022 (An Act to Implement Medical Loss Ratios for Dental Benefit Plans) | Mass.gov
The purpose of these information sessions was to listen to thoughts about future regulations, bulletins and other guidance, including question and answer documents, that the Division should consider regarding this newly enacted statute.