{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-6105.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-6105.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-6105.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-6105.html"}],"law_id":55922,"edition_id":1,"section_id":55922,"structure_id":13837,"section_number":"38.2-6105","catch_line":"Required dental benefit contract provisions","history":"2004, c. 668.","full_text":"A\n\nEach dental benefit contract shall contain the following provisions:1\n\nAn effective date of the contract;2\n\nA provision describing the payment of required subscription fees or premiums;3\n\nA grace period provision that complies with § 38.2-6107;4\n\nFor group dental benefit contracts, the eligibility requirements and effective date of coverage for subscribers of the group and their dependents;5\n\nA provision describing the benefits available under the dental benefit contract;6\n\nA provision describing the copayments and deductibles for which the enrollee is responsible or the fixed indemnity benefits, if any;7\n\nA provision describing the service area, if applicable;8\n\nIf a dental plan organization provides benefits only within a stated service area, a provision providing for emergency dental services outside the service area, with the term “emergency” including care to alleviate acute pain;9\n\nA provision indicating that if a plan dentist refers the enrollee to a specialist who is not a plan dentist for dental services that are covered under the dental benefit contract, the dental plan organization shall be responsible for payment of the specialist’s charges to the extent the charges exceed the copayment specified in the dental benefit contract;10\n\nA provision that reads substantially as follows, if the contract requires use of a plan dentist:\n\t\t\t\t“If during the term of this contract none of the plan dentists can render necessary care and treatment to the enrollee due to circumstances not reasonably within the control of the dental plan organization, such as complete or partial destruction of facilities, war, riot, civil insurrection, labor disputes, or the disability of a significant number of the plan dentists, then the enrollee may seek treatment from an independent licensed dentist of his own choosing. The dental plan organization will pay the enrollee for the expenses incurred for the dental services with the following limitations: The dental plan organization will pay the enrollee for services that are listed in the patient charge schedule as “No Charge,” to the extent that such fees are reasonable and customary for dentists in the same geographic area; the dental plan organization will also pay the enrollee for those services listed in the contract for which there is a copayment, to the extent that the reasonable and customary fees for such services exceed the copayment for such services as set forth in the contract. The enrollee may be required to give written proof of loss.”;11\n\nA provision setting out the terms under which coverage will terminate; and12\n\nA provision setting out a grievance procedure that specifies the time period in which the dental plan organization shall initially respond to an enrollee’s grievance, with the time period not exceeding 20 days from the date the grievance is filed with the dental plan organization.B\n\nEach dental benefit contract shall also have provisions related to extension of benefits that specify:1\n\nIf an enrollee’s coverage terminates, an extension of benefits shall be provided for any treatment in progress at the time of termination, provided the treatment requires two or more visits to the dentist’s office on separate days as certified by the treating dentist.2\n\nThe extension of benefits shall be, at a minimum, for all types of dental care other than orthodontics, until the completion of the procedure.3\n\nFor orthodontics, the extension of benefits will be at least 60 days if the orthodontist has agreed to or is receiving monthly payments when coverage terminates, or if the orthodontist has agreed to accept or is receiving payments on a quarterly basis, to the end of the quarter in progress or 60 days, whichever is longer.4\n\nAn extension of benefits is not required if termination is due solely to the failure of the enrollee to pay the subscription fee or premium when the enrollee is otherwise eligible to continue coverage under the dental benefit contract.","order_by":null,"text":{"0":{"id":204855,"text":"Each dental benefit contract shall contain the following provisions:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":204856,"text":"An effective date of the contract;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":204857,"text":"A provision describing the payment of required subscription fees or premiums;","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":204858,"text":"A grace period provision that complies with § 38.2-6107;","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"A4"},"4":{"id":204859,"text":"For group dental benefit contracts, the eligibility requirements and effective date of coverage for subscribers of the group and their dependents;","type":"section","prefixes":["A","4"],"prefix":"4","entire_prefix":"A4","prefix_anchor":"A4","level":2,"prior_prefix":"A3","next_prefix":"A5"},"5":{"id":204860,"text":"A provision describing the benefits available under the dental benefit contract;","type":"section","prefixes":["A","5"],"prefix":"5","entire_prefix":"A5","prefix_anchor":"A5","level":2,"prior_prefix":"A4","next_prefix":"A6"},"6":{"id":204861,"text":"A provision describing the copayments and deductibles for which the enrollee is responsible or the fixed indemnity benefits, if any;","type":"section","prefixes":["A","6"],"prefix":"6","entire_prefix":"A6","prefix_anchor":"A6","level":2,"prior_prefix":"A5","next_prefix":"A7"},"7":{"id":204862,"text":"A provision describing the service area, if applicable;","type":"section","prefixes":["A","7"],"prefix":"7","entire_prefix":"A7","prefix_anchor":"A7","level":2,"prior_prefix":"A6","next_prefix":"A8"},"8":{"id":204863,"text":"If a dental plan organization provides benefits only within a stated service area, a provision providing for emergency dental services outside the service area, with the term “emergency” including care to alleviate acute pain;","type":"section","prefixes":["A","8"],"prefix":"8","entire_prefix":"A8","prefix_anchor":"A8","level":2,"prior_prefix":"A7","next_prefix":"A9"},"9":{"id":204864,"text":"A provision indicating that if a plan dentist refers the enrollee to a specialist who is not a plan dentist for dental services that are covered under the dental benefit contract, the dental plan organization shall be responsible for payment of the specialist’s charges to the extent the charges exceed the copayment specified in the dental benefit contract;","type":"section","prefixes":["A","9"],"prefix":"9","entire_prefix":"A9","prefix_anchor":"A9","level":2,"prior_prefix":"A8","next_prefix":"A10"},"10":{"id":204865,"text":"A provision that reads substantially as follows, if the contract requires use of a plan dentist:\n\t\t\t\t“If during the term of this contract none of the plan dentists can render necessary care and treatment to the enrollee due to circumstances not reasonably within the control of the dental plan organization, such as complete or partial destruction of facilities, war, riot, civil insurrection, labor disputes, or the disability of a significant number of the plan dentists, then the enrollee may seek treatment from an independent licensed dentist of his own choosing. The dental plan organization will pay the enrollee for the expenses incurred for the dental services with the following limitations: The dental plan organization will pay the enrollee for services that are listed in the patient charge schedule as “No Charge,” to the extent that such fees are reasonable and customary for dentists in the same geographic area; the dental plan organization will also pay the enrollee for those services listed in the contract for which there is a copayment, to the extent that the reasonable and customary fees for such services exceed the copayment for such services as set forth in the contract. The enrollee may be required to give written proof of loss.”;","type":"section","prefixes":["A","10"],"prefix":"10","entire_prefix":"A10","prefix_anchor":"A10","level":2,"prior_prefix":"A9","next_prefix":"A11"},"11":{"id":204866,"text":"A provision setting out the terms under which coverage will terminate; and","type":"section","prefixes":["A","11"],"prefix":"11","entire_prefix":"A11","prefix_anchor":"A11","level":2,"prior_prefix":"A10","next_prefix":"A12"},"12":{"id":204867,"text":"A provision setting out a grievance procedure that specifies the time period in which the dental plan organization shall initially respond to an enrollee’s grievance, with the time period not exceeding 20 days from the date the grievance is filed with the dental plan organization.","type":"section","prefixes":["A","12"],"prefix":"12","entire_prefix":"A12","prefix_anchor":"A12","level":2,"prior_prefix":"A11","next_prefix":"B"},"13":{"id":204868,"text":"Each dental benefit contract shall also have provisions related to extension of benefits that specify:","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A12","next_prefix":"B1"},"14":{"id":204869,"text":"If an enrollee’s coverage terminates, an extension of benefits shall be provided for any treatment in progress at the time of termination, provided the treatment requires two or more visits to the dentist’s office on separate days as certified by the treating dentist.","type":"section","prefixes":["B","1"],"prefix":"1","entire_prefix":"B1","prefix_anchor":"B1","level":2,"prior_prefix":"B","next_prefix":"B2"},"15":{"id":204870,"text":"The extension of benefits shall be, at a minimum, for all types of dental care other than orthodontics, until the completion of the procedure.","type":"section","prefixes":["B","2"],"prefix":"2","entire_prefix":"B2","prefix_anchor":"B2","level":2,"prior_prefix":"B1","next_prefix":"B3"},"16":{"id":204871,"text":"For orthodontics, the extension of benefits will be at least 60 days if the orthodontist has agreed to or is receiving monthly payments when coverage terminates, or if the orthodontist has agreed to accept or is receiving payments on a quarterly basis, to the end of the quarter in progress or 60 days, whichever is longer.","type":"section","prefixes":["B","3"],"prefix":"3","entire_prefix":"B3","prefix_anchor":"B3","level":2,"prior_prefix":"B2","next_prefix":"B4"},"17":{"id":204872,"text":"An extension of benefits is not required if termination is due solely to the failure of the enrollee to pay the subscription fee or premium when the enrollee is otherwise eligible to continue coverage under the dental benefit contract.","type":"section","prefixes":["B","4"],"prefix":"4","entire_prefix":"B4","prefix_anchor":"B4","level":2,"prior_prefix":"B3"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-6105\/","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":false,"refers_to":[{"id":56985,"section_number":"38.2-6107","catch_line":"Grace period requirements","order_by":null,"url":"\/38.2-6107\/"}],"permalink":{"id":218255,"object_type":"law","relational_id":55922,"identifier":"38.2-6105","token":"38.2\/61\/38.2-6105","url":"\/38.2-6105\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-6105\/","token":"38.2\/61\/38.2-6105","dublin_core":{"Title":"Required dental benefit contract provisions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-6105","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each dental benefit contract<\/span> shall contain the following provisions: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> An effective date of the contract; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> A provision describing the payment of required subscription fees or premiums; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A grace period provision that complies with § 38.2-6107<\/a>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> For group dental benefit contracts<\/span>, the eligibility requirements and effective date of coverage for subscribers<\/span> of the group and their dependents<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> A provision describing the benefits available under the dental benefit contract<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> A provision describing the copayments<\/span> and deductibles for which the enrollee<\/span> is responsible or the fixed indemnity benefits<\/span>, if any; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> A provision describing the service area, if applicable; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> If a dental plan organization<\/span> provides benefits only within a stated service area, a provision providing for emergency dental services<\/span> outside the service area, with the term “emergency” including care to alleviate acute pain; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

9.<\/span> A provision indicating that if a plan dentist<\/span> refers the enrollee<\/span> to a specialist who is not a plan dentist<\/span> for dental services<\/span> that are covered under the dental benefit contract<\/span>, the dental plan organization<\/span> shall be responsible for payment of the specialist’s charges to the extent the charges exceed the copayment<\/span> specified in the dental benefit contract<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

10.<\/span> A provision that reads substantially as follows, if the contract requires use of a plan dentist<\/span>:\n\t\t\t\t“If during the term of this contract none of the plan dentists<\/span> can render necessary care and treatment to the enrollee<\/span> due to circumstances not reasonably within the control of the dental plan organization<\/span>, such as complete or partial destruction of facilities, war, riot, civil insurrection, labor disputes, or the disability of a significant number of the plan dentists<\/span>, then the enrollee<\/span> may seek treatment from an independent licensed dentist of his own choosing. The dental plan organization<\/span> will pay the enrollee<\/span> for the expenses incurred for the dental services<\/span> with the following limitations: The dental plan organization<\/span> will pay the enrollee<\/span> for services that are listed in the patient charge schedule as “No Charge,” to the extent that such fees are reasonable and customary for dentists in the same geographic area; the dental plan organization<\/span> will also pay the enrollee<\/span> for those services listed in the contract for which there is a copayment<\/span>, to the extent that the reasonable and customary fees for such services exceed the copayment<\/span> for such services as set forth in the contract. The enrollee<\/span> may be required to give written proof of loss.”; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

11.<\/span> A provision setting out the terms under which coverage will terminate; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

12.<\/span> A provision setting out a grievance procedure that specifies the time period in which the dental plan organization<\/span> shall initially respond to an enrollee<\/span>’s grievance, with the time period not exceeding 20 days from the date the grievance is filed with the dental plan organization<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Each dental benefit contract<\/span> shall also have provisions related to extension of benefits that specify: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> If an enrollee<\/span>’s coverage terminates, an extension of benefits shall be provided for any treatment in progress at the time of termination, provided the treatment requires two or more visits to the dentist’s office on separate days as certified by the treating dentist. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The extension of benefits shall be, at a minimum, for all types of dental care other than orthodontics, until the completion of the procedure. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> For orthodontics, the extension of benefits will be at least 60 days if the orthodontist has agreed to or is receiving monthly payments when coverage terminates, or if the orthodontist has agreed to accept or is receiving payments on a quarterly basis, to the end of the quarter in progress or 60 days, whichever is longer. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> An extension of benefits is not required if termination is due solely to the failure of the enrollee<\/span> to pay the subscription fee or premium when the enrollee<\/span> is otherwise eligible to continue coverage under the dental benefit contract<\/span>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nREQUIRED DENTAL BENEFIT CONTRACT PROVISIONS (\u00a7 38.2-6105)\n\nA. Each dental benefit contract shall contain the following provisions:\n\n 1. An effective date of the contract;\n\n 2. A provision describing the payment of required subscription fees or\n premiums;\n\n 3. A grace period provision that complies with § 38.2-6107;\n\n 4. For group dental benefit contracts, the eligibility requirements and\n effective date of coverage for subscribers of the group and their dependents;\n\n 5. A provision describing the benefits available under the dental benefit\n contract;\n\n 6. A provision describing the copayments and deductibles for which the\n enrollee is responsible or the fixed indemnity benefits, if any;\n\n 7. A provision describing the service area, if applicable;\n\n 8. If a dental plan organization provides benefits only within a stated\n service area, a provision providing for emergency dental services outside the\n service area, with the term “emergency” including care to\n alleviate acute pain;\n\n 9. A provision indicating that if a plan dentist refers the enrollee to a\n specialist who is not a plan dentist for dental services that are covered\n under the dental benefit contract, the dental plan organization shall be\n responsible for payment of the specialist’s charges to the extent the\n charges exceed the copayment specified in the dental benefit contract;\n\n 10. A provision that reads substantially as follows, if the contract requires\n use of a plan dentist:\n \t\t\t\t“If during the term of this contract none of the plan dentists can\n render necessary care and treatment to the enrollee due to circumstances not\n reasonably within the control of the dental plan organization, such as\n complete or partial destruction of facilities, war, riot, civil insurrection,\n labor disputes, or the disability of a significant number of the plan\n dentists, then the enrollee may seek treatment from an independent licensed\n dentist of his own choosing. The dental plan organization will pay the\n enrollee for the expenses incurred for the dental services with the following\n limitations: The dental plan organization will pay the enrollee for services\n that are listed in the patient charge schedule as “No Charge,” to\n the extent that such fees are reasonable and customary for dentists in the\n same geographic area; the dental plan organization will also pay the enrollee\n for those services listed in the contract for which there is a copayment, to\n the extent that the reasonable and customary fees for such services exceed the\n copayment for such services as set forth in the contract. The enrollee may be\n required to give written proof of loss.”;\n\n 11. A provision setting out the terms under which coverage will terminate; and\n\n 12. A provision setting out a grievance procedure that specifies the time\n period in which the dental plan organization shall initially respond to an\n enrollee’s grievance, with the time period not exceeding 20 days from\n the date the grievance is filed with the dental plan organization.\n\nB. Each dental benefit contract shall also have provisions related to extension\nof benefits that specify:\n\n 1. If an enrollee’s coverage terminates, an extension of benefits shall\n be provided for any treatment in progress at the time of termination, provided\n the treatment requires two or more visits to the dentist’s office on\n separate days as certified by the treating dentist.\n\n 2. The extension of benefits shall be, at a minimum, for all types of dental\n care other than orthodontics, until the completion of the procedure.\n\n 3. For orthodontics, the extension of benefits will be at least 60 days if the\n orthodontist has agreed to or is receiving monthly payments when coverage\n terminates, or if the orthodontist has agreed to accept or is receiving\n payments on a quarterly basis, to the end of the quarter in progress or 60\n days, whichever is longer.\n\n 4. An extension of benefits is not required if termination is due solely to\n the failure of the enrollee to pay the subscription fee or premium when the\n enrollee is otherwise eligible to continue coverage under the dental benefit\n contract.\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}}