                                 CODE OF VIRGINIA

OPTIONAL PROVISIONS (§ 38.2-6106)

Dental benefit contracts may contain the following provisions:

1. A provision including the dental plan organization&#8217;s intention to
charge a specified missed appointment fee. The fee shall be reasonable in
relation to the nature of the procedure for which the missed appointment had
been made. Neither the plan dentist nor the dental plan organization may charge
a missed appointment fee unless this provision appears in the dental benefit
contract. For purposes of this section, the term &#8220;missed
appointment&#8221; means an appointment for which advance cancellation of at
least 24 hours was not provided.

2. A provision including the dental plan organization&#8217;s ability to
increase premiums or subscription fees, with this provision indicating that
these fees may not be increased unless:
			a. The contract holder has been given written notice at least 60 days before
the effective date of the increase; and
			b. In the case of:

   1. An individual contract, present rates under the contract have not been
   changed for at least 12 months, or

   2. A group contract, present rates under the contract have been in effect for
   at least 12 months.

3. A provision including the dental plan organization&#8217;s intention to
impose a financial penalty on an enrollee for voluntarily withdrawing from the
dental plan during the first year of coverage, which penalty may not:
			a. Be charged if the enrollee withdraws from the dental plan after being
covered for at least 12 months; or
			b. Exceed the usual, customary, and reasonable charge for services received
reduced by the sum of the subscription fees paid by or for the enrollee and any
copayments paid by or for the enrollee.

4. A provision including the dental plan organization&#8217;s ability to
increase the patient charge schedule, with the provision indicating that the
increase may not be effective unless the:
			a. Present schedule under the contract has been in effect for at least 12
months; and
			b. Contract holder has been given written notice of the increase at least 60
days before the effective date of the increase.

5. A provision including the dental plan organization&#8217;s rights if an
enrollee refuses to follow a particular course of treatment. The dental plan
organization may not terminate the membership of an enrollee for refusal to
follow a recommended course of treatment for a particular condition. The
provision may indicate that the dental plan organization may refuse to provide
any further benefits for the particular condition if the enrollee refuses to
accept a recommended course of treatment.

6. A provision including the dental plan organization&#8217;s rights if an
enrollee fraudulently uses his membership card or knowingly permits his
membership card to be used by others. The dental plan organization may terminate
an enrollee&#8217;s coverage if the enrollee fraudulently uses his membership
card or knowingly permits his membership card to be used by others. The dental
plan organization may not terminate coverage for an entire family because a
dependent fraudulently uses the membership card. In this instance, only the
dependent&#8217;s coverage may terminate.

7. A provision specifying that the dental plan organization may terminate an
enrollee&#8217;s coverage if the enrollee is unable to maintain a satisfactory
dentist-patient relationship with a plan dentist, provided, however:
			a. Before terminating the enrollee&#8217;s coverage, the dental plan
organization shall permit the enrollee to change primary dentists at least once;
			b. The enrollee shall be given written notice of the termination at least 30
days before the termination of the enrollee&#8217;s membership.

8. If the contract provides coverage for dependent children, the contract shall
also contain the following provision:
			&#8220;Notwithstanding any limiting age stated in the contract, any unmarried
child covered under the contract as a dependent of an enrollee who is chiefly
dependent for support upon the enrollee, and who, at the time of reaching the
limiting age, is incapable of self-support because of mental or physical
incapacity that commenced prior to the child&#8217;s attaining the limiting age,
shall continue to be covered under the contract while remaining so dependent,
unmarried, and mentally or physically incapacitated, until the coverage on the
enrollee upon whom the child is dependent terminates.&#8221;

HISTORY: 2004, c. 668.