The following words and terms, when used in this subchapter,
have the meaning indicated below unless the context clearly indicates
otherwise:
(1) ADA--The American Dental Association.
(2) CDT--The current dental terminology manual developed
and revised periodically by the ADA.
(3) ADA code/dental procedure description--Numerical
codes and corresponding descriptions specified in the CDT to describe
bona fide dental procedures.
(4) Comparable facility--The location where emergency
dental services are rendered, including, but not limited to, the office
of a licensed dentist, a dental clinic, hospital, freestanding emergency
clinic, urgent care clinic, or other facility.
(5) Emergency dental services--Under a single service
plan providing dental care services and benefits, emergency dental
services are limited to procedures administered in a comparable facility,
to evaluate and stabilize dental conditions of a recent onset and
severity accompanied by excessive bleeding, severe pain, or acute
infection that would lead a prudent layperson possessing an average
knowledge of dentistry to believe that immediate care is needed.
(6) Insurer--An insurance company, a group hospital
service corporation operating under Insurance Code Chapter 842 (concerning
Group Hospital Service Corporations), a fraternal benefit society
operating under Insurance Code Chapter 885 (concerning Fraternal Benefit
Societies), or a stipulated premium insurance company operating under
Insurance Code Chapter 884 (concerning Stipulated Premium Insurance
Companies).
(7) Point-of-service group disclosure statement--A
written statement containing information about dental benefits that
the HMO must provide to:
(A) an employer, an association, or other private group
arrangement to whom the HMO must offer a dental point-of-service plan;
and
(B) any prospective enrollees in a dental point-of-service
plan, if the employer, association, or private group arrangement accepts
the dental point-of-service plan.
(8) Point-of-service plan--A plan provided through
a contractual arrangement under which indemnity benefits for the cost
of dental care services other than emergency care or emergency dental
care are provided by an insurer in conjunction with corresponding
benefits arranged or provided by an HMO that provides dental benefits
and under which an enrollee may choose to obtain benefits or services
under either the indemnity plan or the HMO plan in compliance with
Insurance Code §843.112 (concerning Dental Point-of-Service Option).
(9) Qualified actuary--As defined in §11.702 of
this title (relating to Actuarial Certification).
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