PA HB1325

Health insurers must submit annual medical loss ratio (MLR) reports for dental policies to the Pennsylvania Insurance Department by April 30 each year, with data organized by market and product type

MLR calculated as percentage of premium dollars spent on patient care, including clinical dental services and up to 5% for quality improvement activities, excluding administrative costs like marketing, claims operations, and payroll

Reports must follow federal CMS Medical Loss Ratio Annual Reporting Form (CMS-10418) requirements and be consistent with 42 U.S.C. § 300gg-18 and 45 CFR Part 158

Insurance Commissioner may impose civil penalties up to $5,000 per violation ($10,000 for willful violations), with aggregate penalties capped at $500,000 per calendar year; may also suspend or revoke insurer licenses

Exemptions apply to Medicaid, CHIP (Children's Health Insurance Program), and other Commonwealth-sponsored health programs