This is not a dental insurance plan.
- Patient portion of the bill is due at time of scheduling.
- This Plan cannot be used in conjunction with another dental plan or dental insurance.
- No refunds of premiums will be issued if a participant decides not to utilize dental plan
- No membership card will be given. Your plan's effective date will be on file in our office.
- This Plan cannot be used at any office other than this office and its providers.
- This Plan cannot be used for referral to specialists or for hospital care. The plan cannot be used for costs of dental care which is covered under automobile medical.
- This Plan cannot be used for injuries covered under workers' compensation claim.
- This Plancannot be used for treatment for which, in the sole opinion of our doctors, lies outside the realm of their capability.
- Family Plan eligibility includes parents and their children (under 18 years of age).
- DSP (Dental Savings Plan) is not transferable.
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L.c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. This is not a Medicare prescription drug plan. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. This plan is accepted at the dental practice where you purchased the plan. If unused, you may cancel within the first 14 days after receipt of membership materials or the effective date, whichever is later, and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN residents will be refunded processing fee). This plan is not available in Vermont or Washington, Utah.
Note: This plan's benefits are automatically terminated upon your activation of a dental insurance plan. As a parting gesture, we will give you a coupon for one free dental cleaning good for twelve months.
Renewal Conditions: By joining, you are authorizing the Plan to bill your credit card or checking account. This charge shall renew until you notify the Plan in writing of its cancellation. By joining you indicate you have read the terms and conditions of the Plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.
Termination Conditions: MERCHANT and the Plan reserve the right to terminate plan members from its plan for any reason, including non-payment. If the Plan terminates the program or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.
Cancellation Conditions: You have the right to cancel within 30 days from the effective date and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the Plan and wish to cancel and obtain a refund, you must submit a written cancellation request. The Plan will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to our MERCHANT Address or fax. You may also submit cancellation requests by email. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in FL, ND and OK, where you will receive a pro-rata refund whenever you cancel.
Description of Services: Please see the product detail page for a specific description of the plan that you have purchased.
Limitations, Exclusions & Exceptions: This plan is offered by MERCHANT. The Plan is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by the Plan. The Plan is not licensed to provide and does not provide medical services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time the Plan may substitute a provider network at its sole discretion. The Plan cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by the Plan are solely responsible for the professional advice and treatment rendered to members and the Plan disclaims any liability with respect to such matters.
Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to MERCHANT Address. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state consumer department.