Gentle Dental Smile Plan Member Terms & Conditions
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:
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.
The Gentle Dental Smile plan does not require a fee for membership in the state of Washington. Plans are offered at no charge to patients without dental insurance.
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.
A Plan fee schedule can be obtained online at 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 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.
Plan in the state of Washington are automatically renewed on an annual basis.
Abusive or Disruptive Behavior – Repeated behavior that substantially impairs the Plan’s ability to furnish or arrange services for you and/or other enrollees or a provider’s ability to provide services to other patients.
Furnishing Incorrect or Incomplete Information: If the Subscriber and/or Member knowingly furnishes incorrect or incomplete information on the application, questionnaire, forms or statements submitted to Dedicated Dental incident to membership, the rights of the Subscriber and/or Member and all dependents may be terminated effective immediately upon written notice.
Misuse of Identification Card: If any Subscriber and/or Member permit the use of his or her Plan identification card by any other person, or use another person’s card, the card may be retained by the Plan, and all rights of the Subscriber and/or Member who wrongfully permitted such use may be terminated effective upon written notice.
The member may cancel his or her membership at any time. Since there are no enrollment fees for the plan, no refund will be given for member fees.
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.
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.
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 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.