ADA Policy on Medical (Dental) Loss Ratio

Council on Dental Benefit Programs seeks member comments

The Council on Dental Benefit Programs of the American Dental Association is seeking member comments on the ADA’s medical (dental) loss ratio (MLR) policy. Every five years, the Council reviews current ADA policies relevant to their purview to update them in response to changing environments. Proposed changes to policies are brought to the ADA House of Delegates with a recommendation either to reaffirm, rescind or amend if updates or revisions are needed. The MLR policy is now under review.

A Dental Loss Ratio requires dental insurance companies to pay a percentage of premiums collected on actual patient care.

The ADA Policy on Medical (Dental) Loss Ratio (Trans. 2015:244; 2019:262) is as follows:

Resolved — that the ADA supports the concept of a “Medical Loss Ratio” for dental plans defined as the proportion of premium revenues that is spent on clinical services, and be it further

Resolved — that dental plans, both for profit and nonprofit should be required to make information available to the general public and to publicize in their marketing materials to plan purchasers and in written communications to their beneficiaries the percentage of premiums that fund treatment and the percentage of premiums that go to administrative costs, promotion, marketing and profit, or in the case of nonprofit entities, reserves, and be it further

Resolved — that the ADA support legislative efforts to require dental benefit plans to file a comprehensive MLR report annually and to establish a specific loss ratio for dental plans in each state and ERISA benefit plans.

Comment Submission

Please provide your comments regarding the policy to inform the Council’s discussions. The deadline for the comment submission period is Monday, April 15, 2024. Consider the following:

  • Does the policy above reflect the best interests of patients and the dental care teams?
  • Should the policy be expanded to include specific definitions for terms (i.e., administrative costs)?
  • Are there gaps in the current policy that can be addressed?

ADA policies guide advocacy efforts on behalf of the profession. Your comments will be used to help the Council on Dental Benefit Programs make recommendations for if and/or how this policy may be revised by the ADA’s House of Delegates at its meeting in October. Until the ADA House of Delegates vote, the current ADA policy remains in effect.

All unique comments will be considered by the Council; bulk comments or spam will not be accepted. Volume of similar comments do not impact final discussions. Thoughtful comments are greatly appreciated. Comments should be focused on the policy above, any comments submitted that do not directly address the policy will be excluded for consideration. All submissions will be deidentified unless you specify otherwise. Comments will be limited to 300 words.