§1164. Dental loss ratio calculations

            The dental loss ratio is calculated by dividing the numerator by the denominator as follows:

            (1)(a) The numerator is the sum of the amount incurred for clinical dental services provided to enrollees, the amount incurred on activities that improve dental care quality, and other incurred claims as defined in 45 CFR 158.140(a).

            (b) The activities to improve dental care quality shall not exceed five percent of the carrier's net revenue.

            (c) Administrative and overhead costs shall not be included in the numerator.

            (2) The denominator is the total amount of premium revenue except for federal and state taxes, licensing and regulatory fees paid, and any nonprofit community benefit expenditures, as defined in 45 CFR 158.162(c), and any other payments required by federal law.

            Acts 2024, No. 357, §1, eff. Jan. 1, 2025.