The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

1. (1) ADA--The American Dental Association.
2. (2) CDT--The current dental terminology users manual developed and revised periodically by the ADA.
3. (3) ADA code/dental procedure description--Numerical codes and corresponding descriptions specified in CDT to describe bona fide dental procedures.
4. (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, or other such facility.
5. (5) Emergency Dental Services--Under a single health care service plan providing dental care services and benefits, emergency dental services are limited to procedures administered in a dentist's office, dental clinic, or other 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. (6) Insurer - An insurance company, a group hospital service corporation operating under Chapter 20 of the Texas Insurance Code, a fraternal benefit society operating under Chapter 10 of the Code, or a stipulated premium insurance company operating under Chapter 22 of the Code.

7. (7) Point-of-service group disclosure statement - A written statement containing information about dental benefits which statement the HMO must provide to:

   1. (A) an employer, an association or other private group arrangement to whom the HMO must offer a dental point-of-service plan; and
   2. (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. (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 accordance with specific provisions of Insurance Code, Article 20A.38.

9. (9) Qualified actuary - An actuary who is either:

   1. (A) a Fellow of the Society of Actuaries, or
   2. (B) a Member of the American Academy of Actuaries.

Source Note:The provisions of this §11.2200 adopted to be effective November 2, 1998, 23 TexReg 11347; amended to be effective May 13, 1999, 24 TexReg 3525.