38.2-6101 - Definitions.
§ 38.2-6101. Definitions.
As used in this chapter:
"Contract holder" means (i) with respect to group contracts, theorganization or entity to which the dental benefit contract is issued, and(ii) with respect to individual contracts, the individual who enters into adental benefit contract covering the individual or the individual anddependents of the individual.
"Copayment" means the amount payable for a particular service by anenrollee in accordance with the patient charge schedule or for which theenrollee is responsible as a condition for receiving benefits under a dentalbenefit contract. A copayment may be expressed as a specific dollar amount oras a percentage of the allowable charge for a service.
"Dental benefit contract" means a contract that provides benefits fordental services entered into between the dental plan organization and acontract holder.
"Dental plan" means a contractual arrangement for dental services providedor arranged for, that pays benefits or is administered on an individual orgroup basis. A dental plan includes, but is not limited to, an arrangementwhere fixed indemnity benefits are paid to an individual or provider fordental services.
"Dental plan organization" means a company that provides directly orarranges for a dental plan.
"Dental service" means a service included in the current Dental TerminologyManual issued by the American Dental Association.
"Dependent" means an individual who is the spouse or child of a subscriber.
"Enrollee" means an individual or a dependent of an individual who isenrolled in a dental plan.
"Evidence of coverage" means any certificate, agreement, or contract issuedto a subscriber of a group that sets out the dental services to which theenrollees are entitled.
"Fixed indemnity benefits" means the payment amount or amounts stated inthe reimbursement schedule of a dental plan organization that will be paid toa subscriber, or to the subscriber's dentist, for dental services.
"Plan dentist" means any dentist, licensed by the Virginia Board ofDentistry, who has contracted with the dental plan organization or with anentity acting on behalf of the dental plan organization to provide dentalservices to the enrollees. A dental plan organization may, but is notrequired to, utilize plan dentists.
"Plan dentist contract" means a contract between the dental planorganization or an entity acting on behalf of the dental plan organizationand a plan dentist.
"Subscriber" means (i) with respect to group dental benefit contracts, theperson who is covered by the contract, other than as a dependent, bysatisfying the eligibility requirements of the group, and (ii) with respectto individual dental benefit contracts, the individual who obtains coverageof the individual only or the individual and dependents of the individual.
(2004, c. 668.)