(215 ILCS 109/10)
Sec. 10.
Definitions.
As used in this Act:
"Dental care services" means services permitted to be performed by a
licensed dentist or any person working under the dentist's supervision as
permitted by law.
"Dentist" means a person licensed to practice dentistry in any state.
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Emergency dental services" means the provision of dental care for a
sudden, acute dental condition that would lead a prudent layperson, who
possesses an average knowledge of dentistry, to reasonably expect the absence
of immediate care to result in serious impairment to the dentition or would
place the person's oral health in serious jeopardy.
"Enrollee" means an individual and his or her dependents who are enrolled
in a managed care dental plan.
"Managed care dental plan" or "plan" means a plan that establishes,
operates, or maintains a network of dentists that have entered into
agreements with the plan to provide dental care services to enrollees to whom
the plan has the obligation to arrange for the provision of or payment for
services through organizational arrangements for ongoing quality assurance,
utilization review programs, or dispute resolution.
For the purpose of this Act, "managed care dental plans" do not include
employee or employer self-insured dental benefit plans under the federal ERISA
Act of 1974.
"Point-of-service plan" means a plan or plans that includes both in-plan
covered services and out-of-plan covered services as well as managed dental
care
plan arrangements in which the risk for out-of-plan covered services is borne
through reinsurance. The term also includes indemnity benefits that are
underwritten in whole by a licensed insurance carrier or a self-funded employer
group. For purposes of this Section, "out-of-plan services" means those
services which are obtained from providers who do not have a contract, or any
other arrangements, with a managed care dental plan or services obtained
without
a referral from providers who have contracted to provide services to the
enrollees on behalf of the managed care dental plan.
"Primary care provider (dentist)" means a dentist, having an arrangement
with a managed care dental plan, selected by an enrollee or assigned to an
enrollee by a plan to provide dental care services under a managed care
dental plan.
"Prospective enrollee" means an individual eligible for enrollment in a
managed care dental plan offered by that individual's employer.
"Provider" means either a general dentist or a dentist who is a licensed
specialist.
(Source: P.A. 91-355, eff. 1-1-00.)
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