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<regulation prefix="Regulation" num=".02" citation="COMAR 31.12.04.02" title_num="31" subtitle_num="12" chapter_num="04" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Closed panel dental benefit contract” means a dental benefit contract that does not provide benefits for services provided by a dentist who is not a plan dentist, with the exception of:</text>
      <paragraph num="(a)">
        <text>Emergency services; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Out-of-network services required by Insurance Article, §15-830, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>“Contract holder” means for:</text>
      <paragraph num="(a)">
        <text>Group contracts, the organization or entity to which the contract is issued;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Individual contracts, the person who applies for a contract covering:</text>
        <paragraph num="(i)">
          <text>One individual, or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>One individual and that individual's dependents.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>“Copayment” means the amount:</text>
      <paragraph num="(a)">
        <text>Payable for a particular service by an enrollee in accordance with the patient charge schedule; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>For which the enrollee is responsible as a condition for receiving benefits under a dental benefit contract.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“Dental benefit contract” means a contract which provides benefits for dental services entered into between the dental plan organization and:</text>
      <paragraph num="(a)">
        <text>An individual contract holder covering the:</text>
        <paragraph num="(i)">
          <text>Subscriber;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Subscriber and the subscriber’s dependents;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Subscriber and the subscriber’s family members;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Subscriber’s dependent or dependents; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Subscriber and the subscriber’s dependents and family members; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The group contract holder covering the:</text>
        <paragraph num="(i)">
          <text>Enrolled members of the group;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Enrolled members of the group and their dependents;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Enrolled members of the group and their family members; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Enrolled members of the group and their dependents and family members.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Dental plan” means any contractual arrangement for dental services.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Dental plan organization” means a:</text>
      <paragraph num="(a)">
        <text>Person that provides directly, arranges for, or administers a dental plan on a prepaid or postpaid individual or group capitation basis; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Nonprofit health service plan which limits its operation to providing directly, or arranging for or administering a plan providing, dental services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>“Dental service” has the meaning stated in Insurance Article, §14-401, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Dependent” means an individual who is the spouse or child of a subscriber.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Enrollee” means a subscriber, or any dependent of the subscriber, who is enrolled in the dental plan organization.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Evidence of coverage” 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.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Patient charge schedule” means a list of amounts which the enrollee is required to pay the plan dentist or the dental plan organization for particular services rendered under the dental benefit contract.</text>
    </paragraph>
    <paragraph num="(12)">
      <text>“Plan dentist” means any dentist 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.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Provider contract” means a contract between the dental plan organization or an entity acting on behalf of the dental plan organization and a plan dentist.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Subscriber” means, for:</text>
      <paragraph num="(a)">
        <text>Group dental benefit contracts, the person who is eligible to be covered under the contract, other than as a dependent, by reason of satisfying the eligibility requirements of the group;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Individual dental benefit contracts, the individual who applies to the dental plan organization for coverage for:</text>
        <paragraph num="(i)">
          <text>That individual only;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The individual and the individual’s dependents; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The individual’s dependent or dependents.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>