S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6254
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               March 7, 2025
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed 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
              

 S. 6254                             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.