House Bill 212 Alabama 2026 Session

Summary

Primary Sponsor

Phillip RigsbyRepresentative

Republican

Session

2026 Regular Session

Title

Dental insurance; set medical loss ratio for insurers

Summary

HB212 would require Alabama stand-alone dental insurers to meet minimum dental loss ratios, issue rebates if they under-spend on claims, and publicly disclose insurer finances.

What This Bill Does

It establishes minimum dental loss ratios of 75% for individual plans and 83% for group plans, calculated over three rolling calendar years. If an insurer spends less on dental care than the minimum, it must refund the difference to enrollees as a rebate or premium credit, with notice within 60 days of the calculation. The bill requires insurers to report income and expenses to the Commissioner of Insurance and makes that information public, defining terms and providing detailed calculation rules and exclusions; it also makes conforming changes to Alabama law and sets an effective date of October 1, 2026.

Who It Affects

• Policyholders enrolled in stand-alone dental plans (individuals and employer groups) who could receive rebates if insurers do not meet the required loss ratio.
• Dental insurers offering stand-alone dental plans; they must meet loss ratio requirements, file periodic reports with the Commissioner of Insurance, and have those reports disclosed publicly.

Key Provisions

• Sets minimum dental loss ratios: 75% for individual plans and 83% for group plans, calculated over three rolling calendar years.
• Calculation method: numerator is aggregated claims paid for dental care; denominator is total premiums collected, with adjustments for reserves, unpaid claims, and recoveries from overpayments or utilization management.
• Exclusions from the loss ratio calculation: a broad list of overhead and administrative expenses (including marketing, enrollment, network, claims processing, provider contracts, employee costs, physical plant, third-party vendor expenses, charitable and industry costs, etc.).
• Rebates: if the DLR is below the required percentage, the insurer must refund the excess premium to enrollees; the rebate amount equals the shortfall in the ratio times total premiums; notification must occur within 60 days and refunds can be paid directly or as a credit on future premiums.
• Reporting and public disclosure: insurers must file a report by April 30 after the end of each reporting period, including market segments, DLR, claims paid, and premiums; the Commissioner will post the information publicly.
• Conforming changes and effective date: amends Sections 10A-20-6.16 and 27-21A-23 for conformity and sets October 1, 2026 as the act’s effective date.

AI-generated summary using openai/gpt-5-nano on Feb 11, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance