{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.17.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.17.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.17.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.17.html"}],"law_id":64799,"edition_id":1,"section_id":64799,"structure_id":12994,"section_number":"38.2-3407.17","catch_line":"Payment for services by dentists and oral surgeons","history":"2010, cc. 583, 734; 2016, c. 556.","full_text":"A\n\nAs used in this section:\n\t\t\t“Covered services” means the health care services for which benefits under a policy, contract, or evidence of coverage are payable by a dental plan, including services paid by the insureds, subscribers, or enrollees because the annual or periodic payment maximum established by the dental plan has been met.\n\t\t\t“Dental plan” includes (i) an insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical, and surgical or major medical coverage on an expense-incurred basis, (ii) an entity providing individual or group accident and sickness subscription contracts, (iii) a dental services plan offering or administering prepaid dental services, (iv) a health maintenance organization providing a health care plan, and (v) a dental plan organization.B\n\nNo contract between a dental plan and a dentist or oral surgeon may establish the fee or rate that the dentist or oral surgeon is required to accept for the provision of health care services, or require that a dentist or oral surgeon accept the reimbursement paid as payment in full, unless the services are covered services under the applicable dental plan.C\n\nA reimbursement payable or paid by a dental plan for covered services shall be reasonable and not provide nominal reimbursement in order to claim that services are covered services under the applicable dental plan. For purposes of this subsection, “reasonable” means the negotiated fee, rate, or reimbursement methodology that is set forth in the contract between a dental plan and a dentist or oral surgeon and is acceptable to the provider.D\n\nThis section, except subsection C, shall apply to any contract between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after July 1, 2010. The provisions of subsection C shall apply to any contract between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after January 1, 2017.E\n\nThe Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.","order_by":null,"text":{"0":{"id":235803,"text":"As used in this section:\n\t\t\t“Covered services” means the health care services for which benefits under a policy, contract, or evidence of coverage are payable by a dental plan, including services paid by the insureds, subscribers, or enrollees because the annual or periodic payment maximum established by the dental plan has been met.\n\t\t\t“Dental plan” includes (i) an insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical, and surgical or major medical coverage on an expense-incurred basis, (ii) an entity providing individual or group accident and sickness subscription contracts, (iii) a dental services plan offering or administering prepaid dental services, (iv) a health maintenance organization providing a health care plan, and (v) a dental plan organization.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":235804,"text":"No contract between a dental plan and a dentist or oral surgeon may establish the fee or rate that the dentist or oral surgeon is required to accept for the provision of health care services, or require that a dentist or oral surgeon accept the reimbursement paid as payment in full, unless the services are covered services under the applicable dental plan.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":235805,"text":"A reimbursement payable or paid by a dental plan for covered services shall be reasonable and not provide nominal reimbursement in order to claim that services are covered services under the applicable dental plan. For purposes of this subsection, “reasonable” means the negotiated fee, rate, or reimbursement methodology that is set forth in the contract between a dental plan and a dentist or oral surgeon and is acceptable to the provider.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":235806,"text":"This section, except subsection C, shall apply to any contract between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after July 1, 2010. The provisions of subsection C shall apply to any contract between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after January 1, 2017.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":235807,"text":"The Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance authorized","url":"\/38.2-3401\/","token":"38.2\/34\/1\/38.2-3401","metadata":false},{"id":65240,"structure_id":12994,"section_number":"38.2-3402","catch_line":"Certification to accompany application","url":"\/38.2-3402\/","token":"38.2\/34\/1\/38.2-3402","metadata":false},{"id":83988,"structure_id":12994,"section_number":"38.2-3403","catch_line":"Fraudulent procurement of policy","url":"\/38.2-3403\/","token":"38.2\/34\/1\/38.2-3403","metadata":false},{"id":65279,"structure_id":12994,"section_number":"38.2-3404","catch_line":"Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies","url":"\/38.2-3404\/","token":"38.2\/34\/1\/38.2-3404","metadata":false},{"id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; 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This law was first created in 2010. The record of its establishment is cataloged in chapters 583<\/a> and 734<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 2016, chapter 556<\/a>.<\/p>","references":[{"id":62548,"section_number":"38.2-4509","catch_line":"Application of certain laws","order_by":null,"url":"\/38.2-4509\/"}],"refers_to":false,"permalink":{"id":215039,"object_type":"law","relational_id":64799,"identifier":"38.2-3407.17","token":"38.2\/34\/1\/38.2-3407.17","url":"\/38.2-3407.17\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.17\/","token":"38.2\/34\/1\/38.2-3407.17","dublin_core":{"Title":"Payment for services by dentists and oral surgeons","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.17","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section:\n\t\t\t“Covered services<\/span>” means the health care services for which benefits under a policy, contract<\/span>, or evidence<\/span> of coverage are payable by a dental plan<\/span>, including services paid by the insureds, subscribers, or enrollees because the annual or periodic payment maximum established by the dental plan<\/span> has been met.\n\t\t\t“Dental plan<\/span>” includes (i) an insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical, and surgical or major medical coverage on an expense-incurred basis, (ii) an entity providing individual or group accident and sickness subscription contracts<\/span>, (iii) a dental services plan offering or administering prepaid dental services, (iv) a health maintenance organization providing a health care plan, and (v) a dental plan<\/span> organization. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> No contract<\/span> between a dental plan<\/span> and a dentist or oral surgeon may establish the fee or rate<\/span> that the dentist or oral surgeon is required to accept for the provision of health care services, or require that a dentist or oral surgeon accept the reimbursement paid as payment in full, unless the services are covered services<\/span> under the applicable dental plan<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A reimbursement payable or paid by a dental plan<\/span> for covered services<\/span> shall be reasonable<\/span> and not provide nominal reimbursement in order<\/span> to claim that services are covered services<\/span> under the applicable dental plan<\/span>. For purposes of this subsection, “reasonable<\/span>” means the negotiated fee, rate<\/span>, or reimbursement methodology that is set forth in the contract<\/span> between a dental plan<\/span> and a dentist or oral surgeon and is acceptable to the provider. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> This section, except subsection C, shall apply to any contract<\/span> between a dental plan<\/span> and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after July 1, 2010. The provisions of subsection C shall apply to any contract<\/span> between a dental plan<\/span> and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after January 1, 2017. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The Commission<\/span> shall have no jurisdiction<\/span> to adjudicate<\/span> individual controversies arising out of this section. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPAYMENT FOR SERVICES BY DENTISTS AND ORAL SURGEONS (\u00a7 38.2-3407.17)\n\nA. As used in this section:\n\t\t\t“Covered services” means the health care services for which\nbenefits under a policy, contract, or evidence of coverage are payable by a\ndental plan, including services paid by the insureds, subscribers, or enrollees\nbecause the annual or periodic payment maximum established by the dental plan\nhas been met.\n\t\t\t“Dental plan” includes (i) an insurer proposing to issue\nindividual or group accident and sickness insurance policies providing hospital,\nmedical, and surgical or major medical coverage on an expense-incurred basis,\n(ii) an entity providing individual or group accident and sickness subscription\ncontracts, (iii) a dental services plan offering or administering prepaid dental\nservices, (iv) a health maintenance organization providing a health care plan,\nand (v) a dental plan organization.\n\nB. No contract between a dental plan and a dentist or oral surgeon may establish\nthe fee or rate that the dentist or oral surgeon is required to accept for the\nprovision of health care services, or require that a dentist or oral surgeon\naccept the reimbursement paid as payment in full, unless the services are\ncovered services under the applicable dental plan.\n\nC. A reimbursement payable or paid by a dental plan for covered services shall\nbe reasonable and not provide nominal reimbursement in order to claim that\nservices are covered services under the applicable dental plan. For purposes of\nthis subsection, “reasonable” means the negotiated fee, rate, or\nreimbursement methodology that is set forth in the contract between a dental\nplan and a dentist or oral surgeon and is acceptable to the provider.\n\nD. This section, except subsection C, shall apply to any contract between a\ndental plan and a dentist or oral surgeon for the provision of health care to\npatients that is entered into, amended, extended, or renewed on or after July 1,\n2010. The provisions of subsection C shall apply to any contract between a\ndental plan and a dentist or oral surgeon for the provision of health care to\npatients that is entered into, amended, extended, or renewed on or after January\n1, 2017.\n\nE. The Commission shall have no jurisdiction to adjudicate individual\ncontroversies arising out of this section.\n\nHISTORY: 2010, cc. 583, 734; 2016, c. 556.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}