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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
729
BY
HEALTH
AND
WELFARE
COMMITTEE
AN
ACT
1
RELATING
TO
THE
IDAHO
DENTAL
PLAN
TRANSPARENCY
ACT;
AMENDING
TITLE
41,
IDAHO
2
CODE,
BY
THE
ADDITION
OF
A
NEW
CHAPTER
67,
TITLE
41,
IDAHO
CODE,
TO
PRO
-
3
VIDE
A
SHORT
TITLE,
TO
DEFINE
TERMS,
AND
TO
PROVIDE
FOR
TRANSPARENCY
4
OF
DENTAL
HEALTH
CARE
SERVICE
PLAN
PATIENT
PREMIUMS;
AND
DECLARING
AN
5
EMERGENCY
AND
PROVIDING
AN
EFFECTIVE
DATE.
6
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
7
SECTION
1.
That
Title
41,
Idaho
Code,
be,
and
the
same
is
hereby
amended
8
by
the
addition
thereto
of
a
NEW
CHAPTER
,
to
be
known
and
designated
as
Chap
-
9
ter
67,
Title
41,
Idaho
Code,
and
to
read
as
follows:
10
CHAPTER
67
1
1
IDAHO
DENTAL
PLAN
TRANSPARENCY
ACT
12
41
-
6701.
SHORT
TITLE.
This
act
shall
be
known
and
may
be
cited
as
the
13
"Idaho
Dental
Plan
Transparency
Act."
14
41
-
6702.
DEFINITIONS.
For
the
purposes
of
this
chapter:
15
(1)
"Dental
health
care
service
plan"
means
any
plan
that
provides
16
coverage
for
dental
health
care
services
to
plan
enrollees
in
exchange
for
17
premiums.
Dental
health
care
service
plan
does
not
include
plans
under
med
-
18
icaid,
the
children's
health
insurance
program
(CHIP),
short
-
term
health
19
plans,
accident
-
only
plans,
emergency
benefits
embedded
in
a
medical
plan,
20
or
direct
primary
care
agreements.
21
(2)
"Dental
loss
ratio"
or
"DLR"
means
a
ratio
used
to
determine
the
22
percentage
of
all
premium
funds
collected
by
an
insurer
or
dental
health
care
23
service
plan
each
year
that
is
spent
on
actual
enrollee
patient
care
and
may
24
include
oral
health
-
related
community
health
benefit
spending
but
shall
not
25
include
overhead
or
other
costs.
26
(3)
"Department"
means
the
Idaho
department
of
insurance.
27
(4)
"Earned
premium"
means
all
moneys
paid
by
an
enrollee
or
subscriber
28
as
a
condition
of
receiving
coverage
from
the
issuer,
including
any
fees
or
29
other
contributions
associated
with
a
dental
health
care
service
plan.
30
(5)
"Incurred
claims"
means
claims
relating
to
services
that
were
pro
-
31
vided
in
a
reporting
year,
which
includes
claims
that
were
paid
in
such
re
-
32
porting
year
plus
unpaid
claim
reserves
for
claims
paid
after
such
reporting
33
year.
34
(6)
"Unpaid
claim
reserves"
means
reserves
and
liabilities
established
35
to
account
for
claims
that
were
incurred
during
a
DLR
reporting
year
but
were
36
not
paid
within
three
(3)
months
of
the
end
of
such
DLR
reporting
year.
37
41
-
6703.
TRANSPARENCY
OF
DENTAL
HEALTH
CARE
SERVICE
PLAN
PATIENT
PRE
-
38
MIUMS.
(1)
A
dental
health
care
service
plan
that
issues,
sells,
renews,
or
39
2
offers
a
specialized
health
care
service
plan
contract
covering
dental
ser
-
1
vices
shall
file
annually
a
DLR
report
with
the
department
that
covers
all
2
dental
health
care
service
plans
offered.
Beginning
in
2027,
such
report
3
shall
be
submitted
annually
on
or
before
July
31.
The
department
shall
an
-
4
nually
review
and
publish
reports
submitted
pursuant
to
this
subsection
by
5
January
1
each
year.
6
(2)
A
DLR
reporting
year
shall
be
for
a
calendar
year
when
dental
cover
-
7
age
was
provided
by
a
dental
health
care
service
plan.
8
(3)
A
DLR
report
shall
include
a
brief
overview
of
what
was
included
9
in
the
calculation
for
the
numerator
and
denominator
of
the
DLR
along
with
10
the
final
ratio
figure.
If
a
dental
health
care
service
plan
includes
oral
1
1
health
-
related
community
health
benefit
spending
in
its
DLR
computation,
it
12
shall
report
the
value
of
any
such
amount
being
included.
13
(4)
If
the
department
requires
additional
data
verification
of
a
dental
14
health
care
service
plan's
representations
pursuant
to
a
DLR
report
submit
-
15
ted
pursuant
to
this
section,
the
department
shall
provide
the
dental
health
16
care
service
plan
with
notification
of
such
requirement
within
thirty
(30)
17
days
after
the
due
date
of
such
DLR
report.
The
dental
health
care
service
18
plan
shall
have
thirty
(30)
days
after
receipt
of
such
notice,
or
such
ad
-
19
ditional
time
as
the
department
may
grant
at
its
discretion,
to
submit
a
re
-
20
sponse.
21
(5)
A
dental
health
care
service
plan
shall
electronically
submit
the
22
information
described
in
this
section
in
a
format
and
according
to
instruc
-
23
tions
prescribed
by
the
department.
24
(6)
By
January
1
of
the
year
after
the
department
has
received
a
DLR
re
-
25
port
pursuant
to
this
section,
the
department
shall
make
such
information,
26
including
the
aggregate
DLR
and
other
data
reported,
available
to
the
public
27
in
a
searchable
format
on
a
website
that
is
available
to
the
public
and
allows
28
for
the
comparison
of
DLRs
among
dental
health
care
service
plans.
29
(7)
DLRs
shall
be
calculated
by
dividing
the
numerator
by
the
denomina
-
30
tor
as
follows:
31
(a)
The
numerator
shall
be
the
amount
spent
on
services
for
plan
en
-
32
rollees.
33
(i)
The
amount
spent
on
services
for
plan
enrollees
includes:
34
1.
The
amount
expended
for
clinical
dental
services
that
are
35
services
within
the
code
on
dental
procedures
and
nomencla
-
36
ture
provided
to
enrollees
that
shall
include
payments
under
37
capitation
contracts
with
dental
providers
whose
services
38
are
covered
by
the
contract
for
dental
clinical
services
or
39
supplies
covered
by
the
contract;
40
2.
Unpaid
claim
reserves;
41
3.
Any
claim
payment
recovered
by
insurers
from
providers
or
42
enrollees
using
utilization
management
efforts
that
shall
43
be
deducted
from
incurred
claim
amounts;
44
4.
The
amount
paid
to
providers
on
activities
that
improve
45
oral
health
through
clinical
services
for
plan
enrollees,
46
limited
to
activities
directed
toward
individual
enrollees;
47
and
48
5.
Oral
health
improvement
activities,
such
as
patient
-
fac
-
49
ing
programs
that
improve
oral
health
outcomes
through
com
-
50
3
munity
outreach,
education,
screening,
grants,
or
workforce
1
development
investment.
2
(ii)
Any
overpayment
that
has
already
been
received
from
3
providers
should
not
be
reported
as
a
paid
claim.
Overpayment
re
-
4
coveries
received
from
providers
shall
be
deducted
from
incurred
5
claim
amounts.
6
(iii)
The
calculation
of
the
numerator
shall
not
include:
7
1.
Any
administrative
costs,
including
but
not
limited
to
8
infrastructure,
personnel
costs,
or
broker
payments;
9
2.
Amounts
paid
to
third
-
party
vendors
for
secondary
net
-
10
work
savings;
1
1
3.
Amounts
spent
internally
or
paid
to
third
-
party
vendors
12
for
network
development,
administrative
fees,
claims
pro
-
13
cessing,
utilization
management,
or
expenditures
designed
14
primarily
to
control
or
contain
costs;
15
4.
Amounts
paid
to
providers
for
professional
or
admin
-
16
istrative
services
that
do
not
represent
compensation
or
17
reimbursement
for
covered
services
provided
to
an
enrollee,
18
including
but
not
limited
to
dental
record
copying
costs,
19
attorney's
fees,
subrogation
vendor
fees,
compensation
to
20
paraprofessionals,
janitors,
quality
assurance
analysts,
21
administrative
supervisors,
secretaries
to
dental
person
-
22
nel,
and
dental
record
clerks;
23
5.
Amounts
for
services
or
expenditures
paid
for
with
grant
24
money
or
other
funding
separate
from
premium
revenue;
25
6.
Any
funds
withheld
from
providers
for
any
reason;
26
7.
Overpayments
recovered
from
providers;
27
8.
Any
cost
-
sharing
amount
paid
by
the
plan
enrollee;
28
9.
Adjustments
recouped
pursuant
to
coordination
of
benefit
29
policies;
30
10.
Payments
recovered
through
fraud
reduction
efforts;
or
31
11.
Share
of
expenses
that
are
for
lines
of
business
or
prod
-
32
ucts
other
than
those
being
reported,
including
but
not
lim
-
33
ited
to
those
that
are
for
or
benefit
self
-
funded
plans
is
-
34
sued
by
the
same
carrier.
35
(b)
The
denominator
shall
be
the
total
amount
of
a
dental
health
care
36
service
plan's
earned
premium
revenues,
excluding
federal
and
state
37
taxes
and
licensing
and
regulatory
fees
paid
after
accounting
for
any
38
payments
pursuant
to
federal
law.
39
SECTION
2.
An
emergency
existing
therefor,
which
emergency
is
hereby
40
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
41
July
1,
2026.
42