To enroll in the benefits plan you must decide on the participation level. Complete the online application form and submit it with the appropriate premium payment and processing fees. The application and payment must be received by the month preceding the period for which coverage is to be effective.
Members may cancel their membership within 30 days if they have not received any discounts associated with the plan. If any discounts were granted to the member within the first 30 day period of membership the member must fulfill their 12 month agreement to maintain the plan. Written notice must be given to cancel the plan within 30 days. Written notice must include all names of participants thy would like to cancel, membership level, participating office phone number and mailing address. With the exception of the cancellation policy listed above this plan is NON-REFUNDABLE. No refunds or premiums will be issued at any time after the thirty day grace period if the participant decides not to utilize the plan.
Cancelled appointments without 1 business day notice will be charged $50/hour of your scheduled appointment time.
Benefits must be used within a 12 month period. 2 cleanings (in the absence of periodontal disease), exam and radiographs. 0 initial sign up fee for any plan
All payments are paid directly by you to the treating office and due at the time of service to receive the discount. Any service/services received that are not paid for at the time of service will be billed at the usual and customary fee.
I have read and understand all the terms and conditions of my plan option. I also understand that membership fees indicated above constitute acceptance for membership. Monthly CC payments: I authorize that my credit card will be kept on file and charged the first month to enroll. Remaining monthly payments will be charged automatically to the same card on the first of the month. I understand the benefits, limitations, exclusions and requirements of the membership. I agree to the following: This authority shall remain in effect for the minimum twelve month period and thereafter revoked by me in writing and until said notice is actually received. I agree that payments of less than 12 months will result in my card being charged the remaining months’ fees in one lump sum. Fees for dental services are paid to the office in full when services are rendered. Fees for prosthodontics and cast restorations are due on the preparation day. Failure to submit payment on the day the services are rendered will result in being charged the usual and customary fee for each service rendered.