Louisiana § 22:1164 Dental loss ratio calculations

Louisiana Statutes

§ 22:1164 — Dental loss ratio calculations

Louisiana·Title 22 Insurance

§1164. Dental loss ratio calculations The dental loss ratio is calculated by dividing the numerator by the denominator as follows:

(1)(a) The numerator is the sum of the amount incurred for clinical dental services provided to enrollees, the amount incurred on activities that improve dental care quality, and other incurred claims as defined in 45 CFR 158.140(a).

(b)The activities to improve dental care quality shall not exceed five percent of the carrier's net revenue.

(c)Administrative and overhead costs shall not be included in the numerator.

(2)The denominator is the total amount of premium revenue except for federal and state taxes, licensing and regulatory fees paid, and any nonprofit community benefit expenditures, as defined in 45 CFR 158.162(c), and any other payments required b

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§1164. Dental loss ratio calculations
The dental loss ratio is calculated by dividing the numerator by the denominator as
follows:
(1)(a) The numerator is the sum of the amount incurred for clinical dental services
provided to enrollees, the amount incurred on activities that improve dental care quality, and
other incurred claims as defined in 45 CFR 158.140(a).
(b) The activities to improve dental care quality shall not exceed five percent of the
carrier's net revenue.
(c) Administrative and overhead costs shall not be included in the numerator.
(2) The denominator is the total amount of premium revenue except for federal and
state taxes, licensing and regulatory fees paid, and any nonprofit community benefit
expenditures, as defined in 45 CFR 158.162(c), and any other payments required by federal
law.

Louisiana § 22:1164 (Dental loss ratio calculations) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.