Dental loss ratio: Putting patient care first

Overview of legislation in 2025

The term “dental loss ratio” has been in the headlines the past few years, with nearly half the U.S. states having made moves to increase the amount of insurance premium revenue spent on patient care vs. operating costs. 

In 2025, what does the landscape of dental loss ratio legislation look like? Twenty-three states have filed dental loss ratio legislation since 2023, with 14 states having introduced legislation this year. Illinois, Nebraska, New York, Oklahoma, Pennsylvania, Rhode Island, Virginia, Washington, West Virginia introduced legislation for dental loss ratios in 2024, and Arizona, Colorado and Nevada in 2023. 

North Dakota became the most recent state to pass dental loss ratio legislation, when Gov. Kelly Armstrong signed House Bill 1481 into law April 18. H.B. 1481 passed the House 85-2 and was approved by the Senate 40-7. The bill sets a minimum dental loss ratio of 75% with a required refund for carriers reporting below that mark. The dental insurer will be required to provide notice to all individuals and groups covered under the plan during the applicable period that they are entitled to a refund on the premium, and if they remain covered, that they are eligible for a credit on the premium for the next applicable period. 

Kami Dornfeld, D.D.S., immediate past president of the North Dakota Dental Association, said the effort to pass this legislation was a true grassroots effort that involved members constantly reaching out to state officials to advocate for the bill. 

“We put our boots on the ground to really push it through. And it was a battle,” Dr. Dornfeld said. “It really took everybody on this one.”

According to Dr. Dornfeld, several insurance lobbyists and one member of the House Human Services Committee fought to reject or greatly amend the bill. The bill eventually came out of the House Human Services Committee with a recommendation of “Do Pass,” but she said many North Dakota Dental Association members were still holding their breath as it hit the Senate floor. 

“I think we all were concerned because in any political game, you hear from so many of the senators that ‘Yes, I’m going to vote for it’ but you never really know until they push either that red or green button,” she said. “But I think we all definitely had a huge sigh of relief when it came through on the vote. This will help our patients. That’s what we’re most excited for. That’s what we’re always fighting for is better coverage for our patients.”

State-level reporting on dental loss ratio

Maine passed medical loss ratio reporting law for dental insurance plans in 2022 after the Maine Dental Association submitted a bill that included a rebate for patients, according to Therese Cahill, executive director of the Maine Dental Association. She said the dental association has been watching the data and observing some change in the numbers since the law went into effect.  

“We will continue to monitor the data as we make future determinations about seeking an increase in oversight and/or revisiting legislation to require rebates when the percentage dips below a particular threshold,” she said. “We are hopeful the law helps patients by being transparent about where their payments into their dental insurance benefit are going and encouraging ongoing conversation with their dental providers about this important issue.” 

Here are what other states are considering in 2025, when it comes to dental loss ratio and reporting-only legislation: 

Alabama is considering Senate Bill 203, which would require dental insurers that fail to spend at least 85% of premiums on claims to refund the excess premiums retained to policyholders. State law does not currently regulate how insurers that cover dental care spend the premiums received from individuals and groups that contract for dental care payment or reimbursement.  

Connecticut has filed several vehicle bills intended to provide a forum to discuss legislation establishing a medical loss ratio for dental insurance. Senate Bill 1003 more specifically targets a minimum 83% dental loss ratio for any dental insurance policy issued in the state and require a rebate for investing less than 83%. 

Kansas is considering Senate Bill 182, which would require a dental loss ratio of 85% as of July 1, 2026. The insurance commissioner would calculate the dental loss ratio for each dental carrier, identify the plans that fall below 85% as outliers, and report those plans to the legislature.  The bill gives the insurance commissioner the power to order outlier insurer rebates.  

Minnesota’s Senate File 1204 would require a dental organization’s dental loss ratio to be at least 85%. A dental organization that doesn’t meet the dental loss ratio “must provide remediation to the dental organization’s enrollees,” according to the bill, which said remediation may be achieved by issuing a direct rebate to enrollees, an increase in dental plan benefit limits for the following year or f other methods determined by the commissioner. 

Missouri is considering House Bill 439 and Senate Bill 680, both of which would require dental plans to provide annual rebates to enrollees by Aug. 1 of the year following the applicable plan year if the dental loss ratio for the plan year is less than 85%. 
 
Montana is looking at Senate Bill 335, a bill that would require the commissioner to investigate insurers designated as outliers with respect to helping patients pay for dental care and may require refunds for those insurers continually falling outside of the average loss ratios. Montana does not currently have a reporting requirement. Webb Brown, executive director of the Montana Dental Association, said the bill is the association’s top priority of the session. He said similar bills have appeared in the prior two sessions but didn’t make it out of committee, due in part to strong opposition from insurers. Senate Bill 335, however, has passed second and third readings on the Senate floor and now heads to the House.  

“When it passes into law, our patients will have some assurance that they are getting fair value for their premium dollar. We have gotten strong support from dentists and their dental teams, patients, and of course, the ADA, who is helping us not only with a State Public Affairs grant, but also expertise and support along the way,” Mr. Brown said.  

Nebraska is considering Legislative Bill 639, which would require dental plan carriers to meet a minimum dental loss ratio requirement of 85% by Jan. 1, 2026, failing to do so would require carriers to return excess premiums. Carriers would have to provide an annual dental loss ratio report to the Nebraska Department of Insurance for the previous calendar year. The report would include rates, rating schedules and supporting documentation, including the ratio of incurred claims to earned premiums for each calendar year since the plan’s issuance.  

New Jersey’s Senate Bill 4063 seeks to require dental insurance carriers to report on medical loss ratio annually. Known as the “Transparency for Dental Health Care Costs Act,” the legislation would require carriers to file an annual dental loss ratio report consisting of the number of covered persons, plan cost-sharing and deductible amounts, and the annual maximum coverage limit.    

New York is considering Assembly Bill 3919, which would amend the state’s insurance law to establish a minimum dental loss ratio requirement of 82%. If approved, carriers would annually report the actual loss ratio for the previous calendar year. If an expected loss ratio is not met, the superintendent may direct the corporation to take corrective action.

Oklahoma is considering three bills that would establish dental loss ratio or reporting requirements. House Bill 2805, in its current form, would require dental insurers to file annual dental loss ratio reports for publication.  Plans identified as outliers would be investigated and may be subject to remediation. An average dental loss ratio would be calculated for each market and used to set the minimum DLR that plans that are perpetually operating as an outlier must meet. Other bills filed this year include Senate Bill 1060 which would set a minimum dental loss ratio requirement of 80% for large group plans and 75% for individual and small group plans and Senate Bill 1101 which would require dental insurers to file dental loss ratio reports.  

Washington state initially filed legislation that would set minimum dental loss ratios. The most recent version of the proposal under Senate Bill 5351, as amended after input from legislative leadership, would provide a robust review of the dental loss ratio topic taking in viewpoints from all parties impacted. The project would provide recommendations for legislative action for DLR. An additional provision in the bill says insurers can no longer mix in other states’ data in their required reporting. When insurers report loss ratio and premium activity to the commissioner, as is currently required under state law, the bill directs insurers to limit that information to Washington only and include no other states’ data. 

West Virginia is considering Senate Bill 433 and House Bill 2690, both of which would establish transparency of expenditures of patient premiums, require carriers to file annual reports and provide annual rebates in the form of premium reductions if funds spend for patient care is less than a certain percentage of premium funds. The bills would set a minimum dental loss ratio of 85% for large group plans and 80% for individual or small group plans. H.B. 2785 requires dental loss ratio reporting and commissioner investigation of outlier plans. Remediation is available to the commissioner including rebates and plans continually operating as outliers will have to meet the average dental loss ratio and must offer patient rebates if the dental loss ratio is not met.