Virginia Code 38.2-316.2: Dental carriers; annual actual loss ratio report
A. As used in this section:
Terms Used In Virginia Code 38.2-316.2
- Commission: means the State Corporation Commission. See Virginia Code 38.2-100
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Fraud: Intentional deception resulting in injury to another.
- Includes: means includes, but not limited to. See Virginia Code 1-218
- State: means any commonwealth, state, territory, district or insular possession of the United States. See Virginia Code 38.2-100
“Actual loss ratio” means, for large employer coverage issued by a dental carrier, the ratio of incurred claims and other compensation paid or due to dental providers for the reporting period to earned premiums for dental services provided under a dental carrier contract issued in the Commonwealth, excluding, for the reporting period, (i) related state and federal taxes; (ii) related licensing and regulatory fee expenses; (iii) nonprofit community benefit expenditures, which have been disclosed to the public, to support dental services and improve dental care access and quality in the Commonwealth; (iv) the amounts or related claims payments identified through fraud reduction efforts; and (v) any other related payments required under state or federal law.
“Dental carrier” means (i) any carrier, as defined in § 38.2-3407.15, that offers separate or specific dental policies to large employers; (ii) any nonstock corporation that offers or administers dental services plans, as defined in § 38.2-4501, to large employers; or (iii) a dental plan organization, as defined in § 38.2-6101, that provides coverage to large employers.
“Large employer” means, with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year.
B. Beginning in 2025, each dental carrier shall annually, on or before April 30, file with the Commission a report that includes the actual loss ratio for the preceding calendar year and any such other information as the Commission may require. A dental carrier shall file such report in accordance with the format or forms prescribed by the Commission.
C. The Commission shall annually post such reports on a dedicated link or page on the Commission’s website on or before June 15 after receipt of such reports.