Benefits & Exclusions

Full list of Benefits/Exclusions

Benefits:

No yearly maximums
No deductibles
No claim forms to insurance
No pre-authorization requirements 
No waiting periods
No pre-existing condition limitations
No health questions
Access your personal dental maintenance plan
Coverage for the whole family
Savings on modern dental treatment

Rules, Limitations, and Exclusions:

-This is a membership plan that offers discounted treatment, it is NOT a form of insurance.
-This membership plan is only valid at Primo Smiles. Services performed outside the office are not covered.
-Membership is for 12 consecutive months.
-Membership fees must be paid in full at time of registration, and no refunds will be issued once membership has begun.
-Members CANNOT have any other type of dental insurance/coverage. Obtaining other coverage while a member of membership plan will immediately result in termination of the membership plan. Previously paid fees will not be refunded.
-All fees for services provided must be paid in full at time of service, unless other arrangements have been made prior to service.
-Periodontal patients MUST sign up for the "Periodontal Plan" and are not eligible for the "Adult Plan." Patients who receive periodontal treatment while on the "Adult  Plan" will be allowed to finish their current plan but will be required to switch to the "Periodontal Plan" upon completion.
-Any addition cleanings, exams, or x-rays over the allowed benefit are provided at our usual fees minus the 15% discount.
-Scaling and root planing is not considered a cleaning and is provided at our usual fees minus a 15% discount.
-Patients who have not previously had a comprehensive exam must complete one before entering a plan.  
-Members are responsible for receiving treatment within the twelve-month timeframe.  ---Unused benefits will not be refunded. 
-Failure to show or cancellation of a scheduled cleaning appointment without the required 48-hour notice will count as one of your cleaning occurrences and cannot be made up.
-Rules, limitations, and exclusions are subject to change without notice. 
-Annual Enrollment Fee for each family member is non-refundable.
-Annual Enrollment Fees are due at time of enrollment.
-Plan Effective Date is the date when the Enrollment Fee is paid in full.
-Plans are active for 365 days from the Enrollment Date.
-Enrollment Fee is non-refundable.
-Family members (who must all have the same address) can enroll at different times of the year. However, the end of the Coverage Year shall remain the same for all members, namely based on the Expiration Date of the first family member to enroll. To maximize coverage, all family members should enroll during the same month.
-Plans will only remain active if all treatment is PAID IN FULL at the time of service.
-Participation cannot be combined with any other offer or dental plan.
-All fees shall be based on our practice’s UCR fees and not any other dental plan’s fees.
-Due to administration fees, additional 5% full payment courtesy will not be applied to procedures paid through Care Credit or Lending Club.
-Plans do not apply to dental treatment needed following any type of injury where a lawsuit and therefore outside medical, care, disability or workman’s comp type insurances are involved.
-Enrollment Fees and Plan Benefits are subject to changes during the year.
-Plans are not transferable to another party or family member.
-The patient is responsible for making and keeping appointments.
-Exams, radiographs, cleanings, and other features of the plan must occur within the plan year and cannot be carried over to the next year.
-For an emergency appointment, only examination and radiograph are covered. Patient is responsible for any other dental work completely during the appointment.
-Study models are made for diagnosis proposes only. Patient is responsible for the cost of treatment fabricated using study models.
-If a patient is diagnosed with periodontal disease, they are not eligible for the Preventative Plans.
-If during the course of the plan year, the patient is diagnosed with periodontal disease, the plan will be prorated towards the Periodontal Health Plan. Patient will be responsible for the difference.
-Plan savings apply to dental services only. The following services do not qualify for discounts: Retail products, implant abutments, treatment for sleep disorders, and laboratory fees.
-Plan  discount not applied towards products (i.e. whitening, electronic toothbrushes, arestin etc).
-Child Preventive Plan for patients aged 3-13.