SB 3305

Abstract

Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning January 1, 2025, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Effective January 1, 2025. Senate Committee Amendment No. 2 Deletes reference to: New Act Adds reference to: 215 ILCS 5/356z.71 new Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for medically necessary care and treatment to address a major injury to the jaw either through an accident or disease. Provides that the required coverage may impose the same deductible, coinsurance, or other cost-sharing limitations that are imposed on other related benefits under the policy. Defines "medically necessary care and treatment to address a major injury to the jaw either through an accident or disease". Senate Floor Amendment No. 4 Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2026 (rather than January 1, 2025) shall provide coverage for medically necessary care and treatment to address a major injury to the jaw either through an accident or disease.