{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-6101.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-6101.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-6101.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-6101.html"}],"law_id":54851,"edition_id":1,"section_id":54851,"structure_id":13837,"section_number":"38.2-6101","catch_line":"Definitions","history":"2004, c. 668.","full_text":"As used in this chapter:\n\t\t“Contract holder” means (i) with respect to group contracts, the organization or entity to which the dental benefit contract is issued, and (ii) with respect to individual contracts, the individual who enters into a dental benefit contract covering the individual or the individual and dependents of the individual.\n\t\t“Copayment” means the amount payable for a particular service by an enrollee in accordance with the patient charge schedule or for which the enrollee is responsible as a condition for receiving benefits under a dental benefit contract. A copayment may be expressed as a specific dollar amount or as a percentage of the allowable charge for a service.\n\t\t“Dental benefit contract” means a contract that provides benefits for dental services entered into between the dental plan organization and a contract holder.\n\t\t“Dental plan” means a contractual arrangement for dental services provided or arranged for, that pays benefits or is administered on an individual or group basis. A dental plan includes, but is not limited to, an arrangement where fixed indemnity benefits are paid to an individual or provider for dental services.\n\t\t“Dental plan organization” means a company that provides directly or arranges for a dental plan.\n\t\t“Dental service” means a service included in the current Dental Terminology Manual issued by the American Dental Association.\n\t\t“Dependent” means an individual who is the spouse or child of a subscriber.\n\t\t“Enrollee” means an individual or a dependent of an individual who is enrolled in a dental plan.\n\t\t“Evidence of coverage” means any certificate, agreement, or contract issued to a subscriber of a group that sets out the dental services to which the enrollees are entitled.\n\t\t“Fixed indemnity benefits” means the payment amount or amounts stated in the reimbursement schedule of a dental plan organization that will be paid to a subscriber, or to the subscriber’s dentist, for dental services.\n\t\t“Plan dentist” means any dentist, licensed by the Virginia Board of Dentistry, who has contracted with the dental plan organization or with an entity acting on behalf of the dental plan organization to provide dental services to the enrollees. A dental plan organization may, but is not required to, utilize plan dentists.\n\t\t“Plan dentist contract” means a contract between the dental plan organization or an entity acting on behalf of the dental plan organization and a plan dentist.\n\t\t“Subscriber” means (i) with respect to group dental benefit contracts, the person who is covered by the contract, other than as a dependent, by satisfying the eligibility requirements of the group, and (ii) with respect to individual dental benefit contracts, the individual who obtains coverage of the individual only or the individual and dependents of the individual.","order_by":null,"text":{"0":{"id":201255,"text":"As used in this chapter:\n\t\t“Contract holder” means (i) with respect to group contracts, the organization or entity to which the dental benefit contract is issued, and (ii) with respect to individual contracts, the individual who enters into a dental benefit contract covering the individual or the individual and dependents of the individual.\n\t\t“Copayment” means the amount payable for a particular service by an enrollee in accordance with the patient charge schedule or for which the enrollee is responsible as a condition for receiving benefits under a dental benefit contract. A copayment may be expressed as a specific dollar amount or as a percentage of the allowable charge for a service.\n\t\t“Dental benefit contract” means a contract that provides benefits for dental services entered into between the dental plan organization and a contract holder.\n\t\t“Dental plan” means a contractual arrangement for dental services provided or arranged for, that pays benefits or is administered on an individual or group basis. A dental plan includes, but is not limited to, an arrangement where fixed indemnity benefits are paid to an individual or provider for dental services.\n\t\t“Dental plan organization” means a company that provides directly or arranges for a dental plan.\n\t\t“Dental service” means a service included in the current Dental Terminology Manual issued by the American Dental Association.\n\t\t“Dependent” means an individual who is the spouse or child of a subscriber.\n\t\t“Enrollee” means an individual or a dependent of an individual who is enrolled in a dental plan.\n\t\t“Evidence of coverage” means any certificate, agreement, or contract issued to a subscriber of a group that sets out the dental services to which the enrollees are entitled.\n\t\t“Fixed indemnity benefits” means the payment amount or amounts stated in the reimbursement schedule of a dental plan organization that will be paid to a subscriber, or to the subscriber’s dentist, for dental services.\n\t\t“Plan dentist” means any dentist, licensed by the Virginia Board of Dentistry, who has contracted with the dental plan organization or with an entity acting on behalf of the dental plan organization to provide dental services to the enrollees. A dental plan organization may, but is not required to, utilize plan dentists.\n\t\t“Plan dentist contract” means a contract between the dental plan organization or an entity acting on behalf of the dental plan organization and a plan dentist.\n\t\t“Subscriber” means (i) with respect to group dental benefit contracts, the person who is covered by the contract, other than as a dependent, by satisfying the eligibility requirements of the group, and (ii) with respect to individual dental benefit contracts, the individual who obtains coverage of the individual only or the individual and dependents of the individual.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":13837,"edition_id":1,"name":"Dental Plan Organizations","identifier":"61","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:46:01","date_modified":"2026-06-26 03:46:01","permalink":{"id":218233,"object_type":"structure","relational_id":13837,"identifier":"61","token":"38.2\/61","url":"\/38.2\/61\/","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":64365,"structure_id":13837,"section_number":"38.2-6100","catch_line":"Applicability of chapter","url":"\/38.2-6100\/","token":"38.2\/61\/38.2-6100","metadata":false},{"id":54851,"structure_id":13837,"section_number":"38.2-6101","catch_line":"Definitions","url":"\/38.2-6101\/","token":"38.2\/61\/38.2-6101","metadata":false},{"id":55280,"structure_id":13837,"section_number":"38.2-6102","catch_line":"License application","url":"\/38.2-6102\/","token":"38.2\/61\/38.2-6102","metadata":false},{"id":70748,"structure_id":13837,"section_number":"38.2-6103","catch_line":"Issuance of license; capital and surplus; impairment","url":"\/38.2-6103\/","token":"38.2\/61\/38.2-6103","metadata":false},{"id":71355,"structure_id":13837,"section_number":"38.2-6104","catch_line":"License renewals","url":"\/38.2-6104\/","token":"38.2\/61\/38.2-6104","metadata":false},{"id":55922,"structure_id":13837,"section_number":"38.2-6105","catch_line":"Required dental benefit contract provisions","url":"\/38.2-6105\/","token":"38.2\/61\/38.2-6105","metadata":false},{"id":55174,"structure_id":13837,"section_number":"38.2-6106","catch_line":"Optional provisions","url":"\/38.2-6106\/","token":"38.2\/61\/38.2-6106","metadata":false},{"id":56985,"structure_id":13837,"section_number":"38.2-6107","catch_line":"Grace period requirements","url":"\/38.2-6107\/","token":"38.2\/61\/38.2-6107","metadata":false},{"id":80352,"structure_id":13837,"section_number":"38.2-6108","catch_line":"Plan dentist contracts; preferred providers; assignment of benefits","url":"\/38.2-6108\/","token":"38.2\/61\/38.2-6108","metadata":false},{"id":55124,"structure_id":13837,"section_number":"38.2-6109","catch_line":"Delivery of contract forms","url":"\/38.2-6109\/","token":"38.2\/61\/38.2-6109","metadata":false},{"id":75166,"structure_id":13837,"section_number":"38.2-6110","catch_line":"Filing requirements for premium rates and subscription fees","url":"\/38.2-6110\/","token":"38.2\/61\/38.2-6110","metadata":false},{"id":73622,"structure_id":13837,"section_number":"38.2-6111","catch_line":"Examinations","url":"\/38.2-6111\/","token":"38.2\/61\/38.2-6111","metadata":false},{"id":62574,"structure_id":13837,"section_number":"38.2-6112","catch_line":"Licensing of agents","url":"\/38.2-6112\/","token":"38.2\/61\/38.2-6112","metadata":false},{"id":60406,"structure_id":13837,"section_number":"38.2-6113","catch_line":"Application of other laws","url":"\/38.2-6113\/","token":"38.2\/61\/38.2-6113","metadata":false}],"previous_section":{"id":64365,"structure_id":13837,"section_number":"38.2-6100","catch_line":"Applicability of chapter","url":"\/38.2-6100\/","token":"38.2\/61\/38.2-6100","metadata":false},"next_section":{"id":55280,"structure_id":13837,"section_number":"38.2-6102","catch_line":"License application","url":"\/38.2-6102\/","token":"38.2\/61\/38.2-6102","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-6101\/","history_text":"

This law was first created in 2004. The record of its establishment is cataloged in chapter 668<\/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.<\/p>","references":[{"id":71148,"section_number":"38.2-316.2","catch_line":"Dental carriers; annual actual loss ratio report","order_by":null,"url":"\/38.2-316.2\/"},{"id":55530,"section_number":"38.2-3407.17:1","catch_line":"Payment and reimbursement practices for dental services; network access","order_by":null,"url":"\/38.2-3407.17_1\/"}],"refers_to":false,"permalink":{"id":218239,"object_type":"law","relational_id":54851,"identifier":"38.2-6101","token":"38.2\/61\/38.2-6101","url":"\/38.2-6101\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-6101\/","token":"38.2\/61\/38.2-6101","dublin_core":{"Title":"Definitions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-6101","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

As used in this chapter:\n\t\t“Contract holder<\/span>” means (i) with respect to group contracts, the organization or entity to which the dental benefit contract<\/span> is issued, and (ii) with respect to individual contracts, the individual who enters into a dental benefit contract<\/span> covering the individual or the individual and dependents<\/span> of the individual.\n\t\t“Copayment<\/span>” means the amount payable for a particular service by an enrollee<\/span> in accordance with the patient charge schedule or for which the enrollee<\/span> is responsible as a condition for receiving benefits under a dental benefit contract<\/span>. A copayment<\/span> may be expressed as a specific dollar amount or as a percentage of the allowable charge for a service.\n\t\t“Dental benefit contract<\/span>” means a contract that provides benefits for dental services<\/span> entered into between the dental plan organization<\/span> and a contract holder<\/span>.\n\t\t“Dental plan” means a contractual arrangement for dental services<\/span> provided or arranged for, that pays benefits or is administered on an individual or group basis. A dental plan includes, but is not limited to, an arrangement where fixed indemnity benefits<\/span> are paid to an individual or provider for dental services<\/span>.\n\t\t“Dental plan organization<\/span>” means a company<\/span> that provides directly or arranges for a dental plan.\n\t\t“Dental service<\/span>” means a service included in the current Dental Terminology Manual issued by the American Dental Association.\n\t\t“Dependent<\/span>” means an individual who is the spouse or child of a subscriber<\/span>.\n\t\t“Enrollee<\/span>” means an individual or a dependent<\/span> of an individual who is enrolled in a dental plan.\n\t\t“Evidence of coverage<\/span>” means any certificate, agreement, or contract issued to a subscriber<\/span> of a group that sets out the dental services<\/span> to which the enrollees<\/span> are entitled.\n\t\t“Fixed indemnity benefits<\/span>” means the payment amount or amounts stated in the reimbursement schedule of a dental plan organization<\/span> that will be paid to a subscriber<\/span>, or to the subscriber<\/span>’s dentist, for dental services<\/span>.\n\t\t“Plan dentist” means any dentist, licensed by the Virginia Board of Dentistry, who has contracted with the dental plan organization<\/span> or with an entity acting on behalf of the dental plan organization<\/span> to provide dental services<\/span> to the enrollees<\/span>. A dental plan organization<\/span> may, but is not required to, utilize plan dentists<\/span>.\n\t\t“Plan dentist contract<\/span>” means a contract between the dental plan organization<\/span> or an entity acting on behalf of the dental plan organization<\/span> and a plan dentist.\n\t\t“Subscriber<\/span>” means (i) with respect to group dental benefit contracts<\/span>, the person<\/span> who is covered by the contract, other than as a dependent<\/span>, by satisfying the eligibility requirements of the group, and (ii) with respect to individual dental benefit contracts<\/span>, the individual who obtains coverage of the individual only or the individual and dependents<\/span> of the individual.<\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEFINITIONS (\u00a7 38.2-6101)\n\nAs used in this chapter:\n\t\t“Contract holder” means (i) with respect to group contracts, the\norganization or entity to which the dental benefit contract is issued, and (ii)\nwith respect to individual contracts, the individual who enters into a dental\nbenefit contract covering the individual or the individual and dependents of the\nindividual.\n\t\t“Copayment” means the amount payable for a particular service by\nan enrollee in accordance with the patient charge schedule or for which the\nenrollee is responsible as a condition for receiving benefits under a dental\nbenefit contract. A copayment may be expressed as a specific dollar amount or as\na percentage of the allowable charge for a service.\n\t\t“Dental benefit contract” means a contract that provides benefits\nfor dental services entered into between the dental plan organization and a\ncontract holder.\n\t\t“Dental plan” means a contractual arrangement for dental services\nprovided or arranged for, that pays benefits or is administered on an individual\nor group basis. A dental plan includes, but is not limited to, an arrangement\nwhere fixed indemnity benefits are paid to an individual or provider for dental\nservices.\n\t\t“Dental plan organization” means a company that provides directly\nor arranges for a dental plan.\n\t\t“Dental service” means a service included in the current Dental\nTerminology Manual issued by the American Dental Association.\n\t\t“Dependent” means an individual who is the spouse or child of a\nsubscriber.\n\t\t“Enrollee” means an individual or a dependent of an individual who\nis enrolled in a dental plan.\n\t\t“Evidence of coverage” means any certificate, agreement, or\ncontract issued to a subscriber of a group that sets out the dental services to\nwhich the enrollees are entitled.\n\t\t“Fixed indemnity benefits” means the payment amount or amounts\nstated in the reimbursement schedule of a dental plan organization that will be\npaid to a subscriber, or to the subscriber’s dentist, for dental services.\n\t\t“Plan dentist” means any dentist, licensed by the Virginia Board\nof Dentistry, who has contracted with the dental plan organization or with an\nentity acting on behalf of the dental plan organization to provide dental\nservices to the enrollees. A dental plan organization may, but is not required\nto, utilize plan dentists.\n\t\t“Plan dentist contract” means a contract between the dental plan\norganization or an entity acting on behalf of the dental plan organization and a\nplan dentist.\n\t\t“Subscriber” means (i) with respect to group dental benefit\ncontracts, the person who is covered by the contract, other than as a dependent,\nby satisfying the eligibility requirements of the group, and (ii) with respect\nto individual dental benefit contracts, the individual who obtains coverage of\nthe individual only or the individual and dependents of the individual.\n\nHISTORY: 2004, c. 668.","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}}