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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>54851</law_id><section_number>38.2-6101</section_number><catch_line>Definitions</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-316.2</reference><reference>38.2-3407.17:1</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="61">Dental Plan Organizations</unit></structure><text>
						<section><p>As used in this chapter:
		&#x201C;<span class="dictionary">Contract holder</span>&#x201D; means (i) with respect to group contracts, the organization or entity to which the <span class="dictionary">dental benefit contract</span> is issued, and (ii) with respect to individual contracts, the individual who enters into a <span class="dictionary">dental benefit contract</span> covering the individual or the individual and <span class="dictionary">dependents</span> of the individual.
		&#x201C;<span class="dictionary">Copayment</span>&#x201D; means the amount payable for a particular service by an <span class="dictionary">enrollee</span> in accordance with the patient charge schedule or for which the <span class="dictionary">enrollee</span> is responsible as a condition for receiving benefits under a <span class="dictionary">dental benefit contract</span>. A <span class="dictionary">copayment</span> may be expressed as a specific dollar amount or as a percentage of the allowable charge for a service.
		&#x201C;<span class="dictionary">Dental benefit contract</span>&#x201D; means a contract that provides benefits for <span class="dictionary">dental services</span> entered into between the <span class="dictionary">dental plan organization</span> and a <span class="dictionary">contract holder</span>.
		&#x201C;Dental plan&#x201D; means a contractual arrangement for <span class="dictionary">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 <span class="dictionary">fixed indemnity benefits</span> are paid to an individual or provider for <span class="dictionary">dental services</span>.
		&#x201C;<span class="dictionary">Dental plan organization</span>&#x201D; means a <span class="dictionary">company</span> that provides directly or arranges for a dental plan.
		&#x201C;<span class="dictionary">Dental service</span>&#x201D; means a service included in the current Dental Terminology Manual issued by the American Dental Association.
		&#x201C;<span class="dictionary">Dependent</span>&#x201D; means an individual who is the spouse or child of a <span class="dictionary">subscriber</span>.
		&#x201C;<span class="dictionary">Enrollee</span>&#x201D; means an individual or a <span class="dictionary">dependent</span> of an individual who is enrolled in a dental plan.
		&#x201C;<span class="dictionary">Evidence of coverage</span>&#x201D; means any certificate, agreement, or contract issued to a <span class="dictionary">subscriber</span> of a group that sets out the <span class="dictionary">dental services</span> to which the <span class="dictionary">enrollees</span> are entitled.
		&#x201C;<span class="dictionary">Fixed indemnity benefits</span>&#x201D; means the payment amount or amounts stated in the reimbursement schedule of a <span class="dictionary">dental plan organization</span> that will be paid to a <span class="dictionary">subscriber</span>, or to the <span class="dictionary">subscriber</span>&#x2019;s dentist, for <span class="dictionary">dental services</span>.
		&#x201C;Plan dentist&#x201D; means any dentist, licensed by the Virginia Board of Dentistry, who has contracted with the <span class="dictionary">dental plan organization</span> or with an entity acting on behalf of the <span class="dictionary">dental plan organization</span> to provide <span class="dictionary">dental services</span> to the <span class="dictionary">enrollees</span>. A <span class="dictionary">dental plan organization</span> may, but is not required to, utilize <span class="dictionary">plan dentists</span>.
		&#x201C;<span class="dictionary">Plan dentist contract</span>&#x201D; means a contract between the <span class="dictionary">dental plan organization</span> or an entity acting on behalf of the <span class="dictionary">dental plan organization</span> and a plan dentist.
		&#x201C;<span class="dictionary">Subscriber</span>&#x201D; means (i) with respect to group <span class="dictionary">dental benefit contracts</span>, the <span class="dictionary">person</span> who is covered by the contract, other than as a <span class="dictionary">dependent</span>, by satisfying the eligibility requirements of the group, and (ii) with respect to individual <span class="dictionary">dental benefit contracts</span>, the individual who obtains coverage of the individual only or the individual and <span class="dictionary">dependents</span> of the individual.</p></section></text><history>2004, c. 668.</history><metadata></metadata></law>
