House Bill 1535 adds new requirements and restrictions to Washington insurance law for dental benefits and dental-only plans and amends existing statutes (RCW 48.44.035, 48.44.495, and 48.43.743) while adding new sections to chapters 48.44 and 48.43. It requires limited health care service contractors that offer dental coverage to allow the treating dentist, in consultation with the covered person and based on accepted dental practices, to make all decisions on dental services provided. It prohibits denial of coverage based on an independent diagnosis by the contractor or its agent, denial of coverage for procedures performed the same day, and unilateral midterm reductions of reimbursement rates to contracting dentists without the dentist’s written agreement. It also restricts contracts from forcing dentists to accept contractor-set fees for noncovered services and requires employee benefit plans or health insurance policies to pay noncontracting dentists at least as much as contracting dentists for comparable services. The bill creates new payment and consumer-protection procedures and regulatory requirements: dental insurers or third-party administrators may pay providers by card or electronic transfer that imposes provider fees only if the provider is notified in advance, offered a no-fee alternative, and elects the fee-imposing method; vendors processing payments must comply with the notice requirement. The insurance commissioner is authorized to adopt rules to implement the new sections. Health carriers offering dental-only plans must file rates and group rating factor changes for the next-year January 1 effective date by a date the commissioner sets, submit annual reports (Washington-only data) on dental loss ratios and administrative expense components by April 1, and use a specified dental loss ratio formula (total dental payments divided by total revenue). If a dental-only plan’s annual dental loss ratio is under 85 percent, carriers must refund excess premiums to covered individuals/groups unless the commissioner authorizes a waiver to prevent financial impairment. The bill establishes presumptive disapproval criteria and procedures for plan rates and rating changes: a plan rate is presumptively disapproved if administrative expense increases exceed the most recent dental services CPI increase, reported contribution to surplus exceeds 1.9 percent of total revenue, or the dental loss ratio is less than 85 percent. If the commissioner disapproves a filing, the carrier must be notified at least 45 days before the proposed effective date, may request a hearing within 10 days, the commissioner must hold a hearing within 15 days of the request and issue a decision within 30 days after the hearing, and carriers may not implement disapproved rates unless the commissioner reverses the decision. Important context is missing or incomplete in the provided text: the beginning of some amended subsections, the full contents of section 7 (which is referenced for loss ratio computation), the complete text of section 8, and the statutory definition of “health carriers” in RCW 48.43.743 as used here.

If enacted, dentists who treat patients under dental-only arrangements would have clear authority to make all treatment decisions in consultation with the patient and would be protected from certain insurer practices: carriers could not deny coverage based on the contractor’s independent diagnoses, refuse same-day procedures, or unilaterally cut contracted reimbursement rates midterm without the dentist’s written agreement. Providers could be paid by card or electronic transfer that carries processing fees only if they are warned in advance, given a no-fee alternative, and choose the fee-bearing method, which may shift negotiation over payment method and small fee costs onto providers unless they opt out. Health carriers offering dental-only plans would face new reporting, filing, and oversight requirements: they must submit annual Washington-only data by April 1, file rates by a commissioner-set date, and could be required to refund premiums if a plan’s dental loss ratio is below 85 percent; the commissioner can disapprove rates that, for example, let administrative expenses grow faster than the dental services CPI, set surplus contributions above 1.9 percent of revenue, or produce a loss ratio under 85 percent, with short timelines for hearings and public notice. The practical effect is more administrative work, potential premium refunds, and tighter limits on rate and expense decisions for carriers, while the insurance commissioner gains greater authority to review and reject rates; some important details—such as the exact filing deadline the commissioner will set and the complete computation method for the dental loss ratio—are not included in the provided text.