A. Except as otherwise provided by law, no dental plan organization shall be organized, conducted, or offered in the Commonwealth other than in the manner set forth in this chapter. B. This chapter shall not apply to a prepaid dental services plan organized under Chapter 45 (§ 38.2-4500 et seq.) of this title, a health […]
As used in this chapter: “Contract holder” 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. “Copayment” means […]
A. No person shall establish or operate a dental plan organization in the Commonwealth without first obtaining a license from the Commission. Any business entity, which is neither an individual nor a sole proprietorship, may apply to the Commission for a license to establish and operate a dental plan organization in compliance with this chapter. […]
A. The Commission shall issue a license to a dental plan organization after the filing of a complete application and payment of a $500 nonrefundable application fee, if the Commission is satisfied that: 1. The persons who are responsible for conducting the affairs of the dental plan organization are trustworthy and capable of providing, arranging […]
A. Each dental plan organization organized under this chapter shall obtain an annual renewal of its license from the Commission by July 1 of each year. The Commission may refuse to renew the license of any dental plan organization or may renew the license, subject to any restrictions considered appropriate by the Commission, if it […]
A. Each dental benefit contract shall contain the following provisions: 1. An effective date of the contract; 2. A provision describing the payment of required subscription fees or premiums; 3. A grace period provision that complies with § 38.2-6107; 4. For group dental benefit contracts, the eligibility requirements and effective date of coverage for subscribers […]
Dental benefit contracts may contain the following provisions: 1. A provision including the dental plan organization’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 […]
The contract holder shall be given a 31-day grace period for the payment of any premium falling due after the first premium during which coverage remains in effect. If payment is not received within the 31 days, coverage may be cancelled after the thirty-first day and the contract holder may be held liable for the […]
A. Each contract with a plan dentist shall contain the following provisions: 1. A hold harmless clause that satisfies the requirements of subdivision C 9 of § 38.2-5805. 2. A provision specifying when the contract becomes effective. 3. A provision specifying the date the contract terminates. 4. A provision specifying the renewal terms. 5. Provisions […]
The dental plan organization: 1. Shall provide a written dental benefit contract to each group contract holder within 15 days of acceptance of the group’s application by the dental plan organization; 2. Shall provide a written evidence of coverage to each individual covered under a group dental benefit contract within 15 days of acceptance of […]
A. The filing with the Commission of any dental benefit contract or rider or endorsement by a dental plan organization shall be accompanied by the filing of premium rates or subscription fees. B. A subsequent change in premium rates or subscription fees shall be filed with supporting data at least 30 days before the change […]
A. The Commission shall examine the affairs of each dental plan organization as provided for in § 38.2-1317. B. Instead of making its own examination, the Commission may accept the report of an examination of a foreign dental plan organization certified by the insurance supervisory official, similar regulatory agency, or the state health commissioner of […]
Dental benefit contracts may be solicited only through health insurance agents and limited lines life and health agents licensed in accordance with Chapter 18 (§ 38.2-1800 et seq.) of this title. Home office salaried officers whose principal duties and responsibilities do not include the negotiation or solicitation of dental benefit contracts shall not be required […]
A. Except to the extent that such application would be inconsistent with any provision of this chapter, the provisions of Chapter 5 (§ 32.1-123 et seq.) of Title 32.1 and of other chapters of this title, and regulations promulgated thereunder, that are applicable to (i) an insurer licensed pursuant to § 38.2-1024, (ii) a carrier […]
