CO| Amended Colorado Regulation 4-2-99 sets out how all carriers offering dental coverage plans, including prepaid dental plans, must calculate, categorize, and report their dental loss ratios (DLRs) by market segment using three years of experience, defining which expenditures count as clinical dental services, quality improvement activities, overhead/administrative costs, and nonprofit community benefit expenditures, and prescribing that the DLR numerator includes clinical claims, qualifying quality improvement spending, and limited fraud-recovery-related amounts while the denominator is premium revenue net of specified taxes, fees, and capped nonprofit community benefit amounts; it also requires annual SERFF DLR and plan design reporting (including top-ten plan metrics and historical data back to 2021 for initial filings), establishes a credibility-adjustment framework based on cumulative member months and a process for identifying low-DLR outlier carriers subject to further review, clarifies that noncompliance may lead to standard insurance law sanctions, and sets an effective date of July 30, 2026.
Home » Bulletins » Colorado Dental Plans: Annual DLR & Plan-Design Reporting Requirements Tighten Under Amended 4-2-99