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Terms and Conditions

Lernor Family Dental’s Dental Savings Plan Terms and Conditions
PLEASE READ THIS BEFORE YOU ACCEPT TERMS AND CONDITIONS! ONCE YOU HAVE ACCEPTED THESE TERMS AND CONDITIONS, THERE ARE NO CHANGES. IF YOU NEED A PAPER COPY TO REVIEW THE TERMS, PLEASE ASK OFFICE ADMINISTRATOR FOR ONE.


The Lernor Family Dental Dental Savings Plan is a membership-based plan that will begin on the first day of enrollment (Plan Start Date) and will expire one day before the original start date of the following year (Plan End Date). This will be considered the “benefit year”. Enrollment/membership will begin on the day in which the patient has completed online enrollment, signed this Terms & Conditions form, and payment of the membership fee is received. This is NOT an insurance plan. I understand that this in-office dental savings plan is not an insurance product. Furthermore, the plan is only for services listed in the plan descriptions performed at the office of Eric W. Lernor DDS PC, 4910 E. Greenway Road, Suite 6, Scottsdale AZ 85254.

I also understand the benefits, limitations, exclusions and requirements of the Plan and I agree to the following: I will remain in the plan and pay membership fees for a minimum of 12 months. Payment of less than 12 months’ membership fees may result in my being charged usual and customary fees for all services (including those already provided) and my being charged remaining membership monthly fees in lump sum. Fees for dental services are due as services are rendered. I agree to auto renew my membership plan with your office each month or each year. If I wish to cancel the plan, I will send a written letter/email of cancellation. There are no refunds for any unused portion of the plan fees paid once the plan is canceled.

This Dental Savings Plan cannot be combined with ANY other discounts. Interest-free financing through CareCredit or any other financing company is not applicable on this plan. If you currently are insured under a traditional dental insurance plan or discount plan that we are contracted with as a “participating/in-network” provider, we would be unable to enroll you as a member due to contractual violations with your insurance company or discount plan.

Fees for prosthodontics and cast restoration services are due at the preparation/impression visit or a payment plan approved and signed must be in place prior at the time of visit. Failure to comply may result in my being charged usual and customary fees for such services.

This Dental Savings Plan cannot be applied towards retail products such as Sonicare toothbrushes, Sonicare toothbrush replacement heads, AirFloss or other oral irrigators MI Paste, or fluoride rinses or toothpastes.

Lernor Family Dental reserves the right to terminate the membership should the need arise in terminating the relationship with the patient due to a severe breach of office policies set forth by Lernor Family Dental. If a patient is being terminated from the practice (and consequently from the membership to the Dental Savings Plan), the patient/member will be notified in writing by US Postal Mail at least 30 days prior to the termination date. No refund will apply.

I agree to pay any and all costs in collecting all charges. Including but not limited to attorney fees and court costs. Coverage must be continuous. Missing monthly payments must be made up for interrupted coverage. Last month fees are not refundable.


DENTAL LIMITATIONS AND EXCLUSIONS

1) Demonstrated non-compliance with recommended course of treatment.

2) Services which in the opinion of the attending dentist are neither necessary nor recommended for the patient’s dental health.

3) Dispensing of drugs not normally supplied in a dental office.

4) Services for injuries or conditions which are covered under Worker’s Compensation or Employer’s Liability laws.

5) Services that cannot be performed because of the general health, physical or psychological limitations of the patient.

6) Plan Participants cannot have other dental coverage.


By signing this form or clicking the acceptance box below, I agree to the terms and conditions of the Lernor Family Dental Dental Savings Plan.
 
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