Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 835 - DENTAL INSURANCE PLAN LOSS RATIO REPORTING
Section 031-835-7 - Average Loss Ratio and Identifying Dental Plan Outliers

Universal Citation: 02 ME Code Rules ยง 031-835-7

Current through 2024-13, March 27, 2024

A. The Superintendent shall calculate the average dental loss ratio for each market segment using aggregate data reported by carriers for the three-year period consisting of the most recent dental loss ratio reporting year and the two prior dental loss ratio reporting years.

B. The Superintendent shall identify as an outlier any dental plan in Maine that falls outside two standard deviations of the average dental loss ratio.

If the average dental loss ratio in a market segment declines for two years in a row, the Superintendent may identify as an outlier any dental plan that falls outside one standard deviation of the average dental loss ratio for that market segment.

C. The Superintendent shall conduct a review of dental plans identified as outliers and require the carriers of each such plan to submit additional financial information necessary to evaluate the reasons those plans are outliers. The Superintendent may also require the carrier to submit a remediation plan, including without limitation measures such as rate revisions or benefit modifications, in a filing using the format prescribed by Rule 940.

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