Adds to existing law to establish the Idaho Dental Plan Transparency Act.

LEGISLATURE OF THE STATE OF IDAHO Sixty-eighth Legislature Second Regular Session - 2026 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. 729 BY HEALTH AND WELFARE COMMITTEE AN ACT1 RELATING TO THE IDAHO DENTAL PLAN TRANSPARENCY ACT; AMENDING TITLE 41, IDAHO2 CODE, BY THE ADDITION OF A NEW CHAPTER 67, TITLE 41, IDAHO CODE, TO PRO-3 VIDE A SHORT TITLE, TO DEFINE TERMS, AND TO PROVIDE FOR TRANSPARENCY4 OF DENTAL HEALTH CARE SERVICE PLAN PATIENT PREMIUMS; AND DECLARING AN5 EMERGENCY AND PROVIDING AN EFFECTIVE DATE.6

Be It Enacted by the Legislature of the State of Idaho:7

SECTION 1. That Title 41, Idaho Code, be, and the same is hereby amended8 by the addition thereto of a NEW CHAPTER, to be known and designated as Chap-9 ter 67, Title 41, Idaho Code, and to read as follows:10 CHAPTER 6711 IDAHO DENTAL PLAN TRANSPARENCY ACT12 41-6701. SHORT TITLE. This act shall be known and may be cited as the13 "Idaho Dental Plan Transparency Act."14 41-6702. DEFINITIONS. For the purposes of this chapter:15 (1) "Dental health care service plan" means any plan that provides16 coverage for dental health care services to plan enrollees in exchange for17 premiums. Dental health care service plan does not include plans under med-18 icaid, the children's health insurance program (CHIP), short-term health19 plans, accident-only plans, emergency benefits embedded in a medical plan,20 or direct primary care agreements.21 (2) "Dental loss ratio" or "DLR" means a ratio used to determine the22 percentage of all premium funds collected by an insurer or dental health care23 service plan each year that is spent on actual enrollee patient care and may24 include oral health-related community health benefit spending but shall not25 include overhead or other costs.26 (3) "Department" means the Idaho department of insurance.27 (4) "Earned premium" means all moneys paid by an enrollee or subscriber28 as a condition of receiving coverage from the issuer, including any fees or29 other contributions associated with a dental health care service plan.30 (5) "Incurred claims" means claims relating to services that were pro-31 vided in a reporting year, which includes claims that were paid in such re-32 porting year plus unpaid claim reserves for claims paid after such reporting33 year.34 (6) "Unpaid claim reserves" means reserves and liabilities established35 to account for claims that were incurred during a DLR reporting year but were36 not paid within three (3) months of the end of such DLR reporting year.37 41-6703. TRANSPARENCY OF DENTAL HEALTH CARE SERVICE PLAN PATIENT PRE-38 MIUMS. (1) A dental health care service plan that issues, sells, renews, or39

2 offers a specialized health care service plan contract covering dental ser-1 vices shall file annually a DLR report with the department that covers all2 dental health care service plans offered. Beginning in 2027, such report3 shall be submitted annually on or before July 31. The department shall an-4 nually review and publish reports submitted pursuant to this subsection by5 January 1 each year.6 (2) A DLR reporting year shall be for a calendar year when dental cover-7 age was provided by a dental health care service plan.8 (3) A DLR report shall include a brief overview of what was included9 in the calculation for the numerator and denominator of the DLR along with10 the final ratio figure. If a dental health care service plan includes oral11 health-related community health benefit spending in its DLR computation, it12 shall report the value of any such amount being included.13 (4) If the department requires additional data verification of a dental14 health care service plan's representations pursuant to a DLR report submit-15 ted pursuant to this section, the department shall provide the dental health16 care service plan with notification of such requirement within thirty (30)17 days after the due date of such DLR report. The dental health care service18 plan shall have thirty (30) days after receipt of such notice, or such ad-19 ditional time as the department may grant at its discretion, to submit a re-20 sponse.21 (5) A dental health care service plan shall electronically submit the22 information described in this section in a format and according to instruc-23 tions prescribed by the department.24 (6) By January 1 of the year after the department has received a DLR re-25 port pursuant to this section, the department shall make such information,26 including the aggregate DLR and other data reported, available to the public27 in a searchable format on a website that is available to the public and allows28 for the comparison of DLRs among dental health care service plans.29 (7) DLRs shall be calculated by dividing the numerator by the denomina-30 tor as follows:31 (a) The numerator shall be the amount spent on services for plan en-32 rollees.33 (i) The amount spent on services for plan enrollees includes:34 1. The amount expended for clinical dental services that are35 services within the code on dental procedures and nomencla-36 ture provided to enrollees that shall include payments under37 capitation contracts with dental providers whose services38 are covered by the contract for dental clinical services or39 supplies covered by the contract;40 2. Unpaid claim reserves;41 3. Any claim payment recovered by insurers from providers or42 enrollees using utilization management efforts that shall43 be deducted from incurred claim amounts;44 4. The amount paid to providers on activities that improve45 oral health through clinical services for plan enrollees,46 limited to activities directed toward individual enrollees;47 and48 5. Oral health improvement activities, such as patient-fac-49 ing programs that improve oral health outcomes through com-50

3 munity outreach, education, screening, grants, or workforce1 development investment.2 (ii) Any overpayment that has already been received from3 providers should not be reported as a paid claim. Overpayment re-4 coveries received from providers shall be deducted from incurred5 claim amounts.6 (iii) The calculation of the numerator shall not include:7 1. Any administrative costs, including but not limited to8 infrastructure, personnel costs, or broker payments;9 2. Amounts paid to third-party vendors for secondary net-10 work savings;11 3. Amounts spent internally or paid to third-party vendors12 for network development, administrative fees, claims pro-13 cessing, utilization management, or expenditures designed14 primarily to control or contain costs;15 4. Amounts paid to providers for professional or admin-16 istrative services that do not represent compensation or17 reimbursement for covered services provided to an enrollee,18 including but not limited to dental record copying costs,19 attorney's fees, subrogation vendor fees, compensation to20 paraprofessionals, janitors, quality assurance analysts,21 administrative supervisors, secretaries to dental person-22 nel, and dental record clerks;23 5. Amounts for services or expenditures paid for with grant24 money or other funding separate from premium revenue;25 6. Any funds withheld from providers for any reason;26 7. Overpayments recovered from providers;27 8. Any cost-sharing amount paid by the plan enrollee;28 9. Adjustments recouped pursuant to coordination of benefit29 policies;30 10. Payments recovered through fraud reduction efforts; or31 11. Share of expenses that are for lines of business or prod-32 ucts other than those being reported, including but not lim-33 ited to those that are for or benefit self-funded plans is-34 sued by the same carrier.35 (b) The denominator shall be the total amount of a dental health care36 service plan's earned premium revenues, excluding federal and state37 taxes and licensing and regulatory fees paid after accounting for any38 payments pursuant to federal law.39

SECTION 2. An emergency existing therefor, which emergency is hereby40 declared to exist, this act shall be in full force and effect on and after41 July 1, 2026.42