02-031 C.M.R. ch. 835, § 4 - Definitions

1. "Administrative cost expenditures" means a carrier's financial administrative, marketing and sales, commission, distribution, claims operation, utilization review, network operations, charitable, and payroll expenses, but does not include expenses specifically recognized under this rule as expenses for activities that improve dental care quality or as community benefit expenses.

2. "Clinical Dental Services" means diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of their profession, including treatment of the teeth and associated structures of the oral cavity and treatment for disease, injury, or impairment that may affect the oral or general health of the enrollee.

3. "Dental plan" has the same meaning as in 24-A M.R.S. §4319-B(1)(A).

4. "Enrollee" has the same meaning as in 24-A M.R.S. §4319-B(1)(A).

5. "Dental loss ratio" has the same meaning as in 24-A M.R.S. §4319-B(2).

6. "Market segment" means the individual, small group as defined by 24-A M. R. S. §2808-B(1)(D), or large group market.

7. "Noncredible plan" means a plan issued by a carrier in a market segment for which the carrier has fewer than 12,000 Maine member months in aggregate for the reporting year, including each covered dependent as a separate member.

Notes

02-031 C.M.R. ch. 835, § 4