§4525.30. Definitions

            Act means the Dental Care Patient Protection Act [215 ILCS 109].

 

            Code means the Illinois Insurance Code [215 ILCS 5].

 

            Dental Director means the dental director of the Illinois Department of Public Health.

 

            Dentist means a person licensed to practice dentistry in any state.

 

            Department means the Illinois Department of Insurance.

 

            Director means the Director of the Illinois Department of Insurance.

 

            Enrollee means an individual and his or her dependents who are enrolled in a managed care dental plan.

 

            Grievance means a written notice relating to the managed care dental plan determinations, procedures, and administration primarily expressing a complaint to the managed care dental plan by, or on behalf of, the enrollee, or by the dental care provider.

 

            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.  Managed care dental plans do not include employee or employer self-insured dental benefit plans under the federal ERISA Act of 1974.

 

            Reasonable Travel Distance means a normal commute of no more than 30 miles or 30 minutes from the residence or place of employment of the enrollee.

 

(Source:  Amended at 33 Ill. Reg. 4967, effective March 23, 2009)