Dear Committee Members:
On behalf of Delta Dental of West Virginia (“Delta Dental”), which provides quality dental coverage to approximately 122,365 West Virginians, thank you for the opportunity to provide input on House Bill 4810.
HB 4810, among other things, seeks to impose an 85% loss ratio requirement similar to that imposed on Affordable Care Act (ACA) exchange medical plans on dental plans. However, dental coverage should not be treated the same as medical coverage. Unlike ACA exchange medical plans, dental plans are unsubsidized and non-standardized. Notably, dental plans were exempted from the ACA’s medical loss ratio requirements, which this proposal is modeled after, because Congress recognized that dental is different.
While medical and dental plans have many similar administrative requirements the similar associated costs, dental plans must meet these requirements with substantially smaller premiums. For example, it is not uncommon for medical plan premiums to average $1000 per member per month (pmpm), while a dental plan premium is often as low as just $20 pmpm. With an 85% loss ratio, this medical plan would pay $850 towards claims, leaving $150 remaining to cover administrative costs. Conversely, a $20 pmpm dental plan would pay $17 towards claims and be left with only $3 left to pay towards administrative costs.
No dental payer can fund a dental plan with just $3 pmpm for administration!
To meet an 85% DLR requirement, dental plans would be forced to raise premiums, cut or eliminate broker commissions, reduce investments in administrative services, and most likely a combination of all three. Dental plans cannot simply increase patient care because coverage levels are set by employers, not dental plans.
An independent 2024 actuarial study of the impact of imposing an 85% DLR on dental plans by the California Health Benefits Review Program (CHBRP) found that some dental plans would need to increase their premiums upwards of 200%, rendering them unaffordable.
[1] This significant premium increase was attributable in part to CHBRP’s finding that meeting an 85% DLR would not be achievable by insurers in that market, even by capping profits at 5% and administrative costs at 10% unless claims expenses were also increased by an aggregate of 288% for HMO products and 52% for PPO products.
[2] Delta Dental’s analysis has shown we would need to increase West Virginia dental premiums by 133%.
Such an increase in premiums will not only negatively impact enrollees and force them to drop their dental coverage, but will also negatively impact providers, as studies have shown that people are much more likely to go to the dentist if they have dental coverage. It is also important to remember that administrative costs include the costs associated with staffing call centers, handling grievances, monitoring fraud, waste, and abuse, credentialing providers, managing networks, and reimbursing providers – all of which are vital to the enrollee and provider experience.
An 85% DLR will limit choice and competition for consumers. Some insurers, particularly those in the small group market, which has reduced economies of scale, will be unable to continue to offer viable products in West Virginia’s market. In 2022, Massachusetts approved a ballot initiative that imposed an 83% DLR on dental plans in that state. As a result, no fewer than 8 carriers were forced to leave the Massachusetts small group market.
[3]
The path forward to providing greater transparency without jeopardizing dental coverage for West Virginians is found in compromise legislation adopted in California, Maine, Nevada, Montana, Louisiana and Virginia. These bills were influenced by model legislation adopted by the National Council of Insurance Legislators in 2024, which was the result of negotiations between the American Dental Association (ADA) and the National Association of Dental Plans (NADP).
[4] The NCOIL model allows states to study DLRs, by requiring insurers to annually report their DLR to the Office of the Insurance Commissioner. Some of the recently enacted compromise bills are “report only” variations. Others empower the Insurance Commissioner to impose remediation on insurers identified as outliers. While we maintain that DLRs are an inappropriate metric by which to measure a benefit with low premiums, measures like those compromise bills are alternatives that we can agree upon.
We urge the committee to preserve choice, competition, and affordability in West Virginia’s dental insurance market and reject this proposal.
Delta Dental appreciates this opportunity to provide comments on HB 4810. Please contact me at
jalbum@delta.org should you have any questions or concerns.
Sincerely,
Jeff Album
Vice-President, Public and Government Affairs
[1] California Health Benefits Review Program. Abbreviated Analysis of California Assembly Bill 2028. 12 Apr. 2024, pp. 9–10, www.chbrp.org/sites/default/files/bill-documents/AB2028/AB%202028%20Medical%20Loss%20Ratios%20Report%20final%20to%20Legislature%2004122024.pdf.
[2] Id.
[3] Bailey, Doug. “NADP: Ameritas, Principal to Leave Massachusetts Small-Plan Dental Market.” Insurance News | InsuranceNewsNet, Oct. 6, 2023, insurancenewsnet.com/innarticle/nadp-ameritas-principal-to-leave-massachusetts-small-plan-dental-market. Accessed Jan. 28, 2026.
[4] American Dental Association, and National Association of Dental Plans. Statement on NCOIL Model Legislation. Jan. 23, 2024, ncoil.org/wp-content/uploads/2024/01/ADA-NADP-NCOIL-Model-Statement-Final-2024-01-23-logos-1.pdf. Accessed Jan. 29, 2026.