                                 CODE OF VIRGINIA

DEFINITIONS (§ 38.2-6101)

As used in this chapter:
		&#8220;Contract holder&#8221; 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.
		&#8220;Copayment&#8221; 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.
		&#8220;Dental benefit contract&#8221; means a contract that provides benefits
for dental services entered into between the dental plan organization and a
contract holder.
		&#8220;Dental plan&#8221; 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.
		&#8220;Dental plan organization&#8221; means a company that provides directly
or arranges for a dental plan.
		&#8220;Dental service&#8221; means a service included in the current Dental
Terminology Manual issued by the American Dental Association.
		&#8220;Dependent&#8221; means an individual who is the spouse or child of a
subscriber.
		&#8220;Enrollee&#8221; means an individual or a dependent of an individual who
is enrolled in a dental plan.
		&#8220;Evidence of coverage&#8221; 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.
		&#8220;Fixed indemnity benefits&#8221; 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&#8217;s dentist, for dental services.
		&#8220;Plan dentist&#8221; 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.
		&#8220;Plan dentist contract&#8221; means a contract between the dental plan
organization or an entity acting on behalf of the dental plan organization and a
plan dentist.
		&#8220;Subscriber&#8221; 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.

HISTORY: 2004, c. 668.