In-House Dental Savings Plan – Kernersville, NC

ARE YOU ELLIGIBLE?

• The Member cannot combine insurance coverage with their membership benefits.
• The Patient must have had a comprehensive exam (D0150) by the Provider to determine if the patient qualifies for the Standard Plan or the Periodontal Plan. Patients who have been diagnosed with Periodontitis are not eligible for the Standard Plan.
• The Member must pay the associated cost for the plan they qualify for.

TERMS & CONDITIONS

• The Provider retains the right to interpret any program stipulations.
• The plan is active and monthly fees are due for one year from effective date. No refunds will be given in the event the Member terminates the plan prior to the end of the plan year.
• The annual membership fee must be paid in full or recurring credit card charges agreed to prior to treatment. Membership fee may be adjusted annually.
• Membership benefits are not transferable, have no cash value and may not be redeemed for cash. This is not an insurance plan and is not subject to regulation by the state department of insurance.
• Plan membership cannot be combined with current dental insurance plans. No insurance claim will be filed for Members under this plan.
• The plan is for individual use only. It is not a group benefits plan.
• Each additional family membership must be paid at the time of the initial membership or at renewal time.
• Members are responsible for notifying dental practice of any address or contact changes.
• Missed appointment fees/penalties are ineligible for the membership discount.
• Total payment amount is due at the time services are provided. If full payment is not received at the time of service, fee discount will be void.