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Gentle Dental Smile Plan Member Terms & Conditions


Updated 10/28/2015

Gentle Dental Smile Plan is administered by Dedicated Dental Systems, Inc. If you have any questions regarding this Plan or the terms and conditions, please call (800) 277-1112 or write:

Dedicated Dental Systems, Inc.
9800 La Cienega Blvd., Suite 800
Inglewood, CA 90301
(800) 277-1112
Fax: (866) 647-0699
www.Dedicated-Dental.com
www.gentledentalsmileplan.com

GENTLE DENTAL SMILE PLAN TERMS & CONDITIONS:

THIS IS NOT INSURANCE. This is a reduced fee dental plan. By paying an annual membership fee to Dedicated Dental you (and if applicable, your eligible family members) will be entitled to receive dental services at reduced rates. A complete fee schedule is available to you and can be found online at www.gentledentalsmileplan.com, at a participating dental provider’s office, or by calling 800-277-1112 .

CHOICE OF DENTISTS

To be entitled to the reduced rates you and your eligible family members must visit a participating provider. A participating provider list can be found online at www.gentledentalsmileplan.com or by calling 800-277-1112.

WHEN MEMBERSHIP BEGINS

Plan membership begins on the calendar day your application is received.

MEMBERSHIP FEES

You are responsible to pay an annual membership fee to participate in this plan. You may obtain information regarding membership fees by contacting the Plan Member Services at (800) 277-1112
Applicable membership fees for the initial year of services are as follows:

Individual - $59/year
Couple - $89/year
Family - $119/year

PLAN ELIGIBILITY

Single individuals, domestic partners, married couples and their dependents are eligible. Dependents are eligible between 4-26 years of age (regardless of whether the dependent is attending school, living outside the parent’s home, or married.) Membership may be continued for a dependent over the age of 26, if the dependent is incapable of self-sustaining employment by reason of developmental or physical handicap.

DISCOUNT FEES

A Plan fee schedule can be obtained online at www.gentledentalsmileplan.com, through a participating provider, or by calling member services; (800) 277-1112.Fees are discounted as listed in the current fee schedule. Fees not listed in the fee schedule will be discounted 20%. Specialty fees will be discounted 25%. Specialty services are available at any participating specialty dental provider.

The Plan reserves the right to update the Plan fee schedule at any time. Update fees will apply to all dental services received by you and your family members.The Plan will send fee schedule change notification 30 days prior to any change.

All provider fees are due at time or service or according to terms between member and provider. The Plan is not responsible for any provider fees.

RENEWAL PROVISIONS

You can renew your plan for an additional year by paying an annual re-enrollment fee to the Plan before your initial eligibility terminates. Dedicated Dental will send you a written notice about this at least thirty (30) days prior to the expiration of eligibility. Upon re-enrollment you (and if applicable your eligible family members) will receive new identification cards.

CANCELLATION POLICY

The member may cancel his/her membership within 30 days of signing-up and will receive a full refund of plan membership fees. However, if services have been performed under the discounted plan rate the provider may charge the member the difference between the provider’s UCR and the plan discount fee.

To receive a refund, please contact member service at (800) 277-1112. Refunds will be processed back to the same method of payment within 15 days of request. If member pays cash or check, member will be refunded by check. Please allow 4 weeks for delivery.

CONFIDENTIALITY OF MEDICAL RECORDS:

The Plan is committed to maintaining the confidentiality and security of all members’ medical information. The Plan complies with all HIPAA laws and regulations. The Plan may not disclose members’ medical information without the member’s authorization, unless required or permitted by law. Any disclosure of medical information beyond the provisions of the law is prohibited

GRIEVANCE PROCESS

Our commitment to you is to ensure not only quality of care, but also quality in the treatment process. This quality of treatment extends from the professional services provided by Plan providers to the courtesy extended to you by our telephone representatives.

If you have questions about the services you receive from a Plan provider, we recommend that you first discuss the matter with your provider. If you continue to have a concern regarding any service you received, please contact us.

Dedicated Dental Systems, Inc.
9800 La Cienega Blvd., Suite 800
Inglewood, CA 90301
Phone: (800) 277-1112
Fax: (866) 647-0699
www.Dedicated-Dental.com
www.gentledentalsmileplan.com

DUAL COVERAGE

The Plan is available to patients without a primary dental policy. The plan is not a supplementary plan and cannot be used in conjunction with other insurance plans.

SPECIALTY SERVICES

Specialty services are covered under the plan, however not all participating providers provide specialty services. You will receive the discounted fees for specialist services under this Plan only if those services are received from a participating provider. If your participating provider does not provide specialist services, you can call Dedicated Dental to see if there is a nearby participating provider who can perform specialty services. Please call 800-277-1112.

THESE TERMS & CONDITIONS ARE BINDING FOR ALL APPLICATION SUBMISSIONS ON PAPER OR ELECTRONIC VIA OUR ONLINE WEBSITE. BY SIGNING OR ACCEPTING THESE TERMS, YOU AGREE TO BE BOUND BY ALL THE TERMS AND CONDITIONS IN THIS DESCRIPTION.