Mass. General Laws c.176X § 1

Definitions

Table of Contents

Updates

Added by St.2022, c.287, § 1, applicable to all dental benefit plans issued, made effective, delivered or renewed on or after January 1, 2024.

Section 1

As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Carrier”, an insurer or other entity offering dental benefit plans in the commonwealth.

“Commissioner”, the commissioner of the division of insurance.

“Connector”, the commonwealth health insurance connector, established by chapter 176Q.

“Dental benefit plans”, any stand-alone dental plan that covers oral surgical care, dental services, dental procedures or benefits covered by any individual, general, blanket or group policy of health, accident and sickness insurance issued by an insurer licensed or otherwise authorized to transact accident and health insurance under chapter 175; any oral surgical care, dental services, dental procedures or benefits covered by a stand-alone individual or group dental medical service plan issued by a non-profit medical service corporation under chapter 176B; any oral surgical care, dental services, dental procedures or benefits covered by a stand-alone individual or group dental service plan issued by a dental service corporation organized under chapter 176E; any oral surgical care, dental services, dental procedures or benefits covered by a stand-alone individual or group dental health maintenance contract issued by a health maintenance organization organized under chapter 176G; or any oral surgical care, dental services, dental procedures or benefits covered by a stand-alone individual or group preferred provider dental plan issued by a preferred provider arrangement organized under chapter 176I. The commissioner may, by regulation, define other dental coverage as a qualifying dental benefit plan for the purposes of this chapter.

“Self-insured customer”, a self-insured group for which a carrier provides administrative services.

“Self-insured group”, a self-insured or self-funded employer group health plan.

“Third-party administrator”, a person or entity that, on behalf of a dental insurer or the MassHealth dental program, or purchaser of dental benefits, provides administrative services including receiving or collecting charges, contributions or premiums for, or adjusting or settling claims on or for residents of the commonwealth.

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Last updated: November 8, 2022

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