Dental Discount Plan

With Your Dental Savings Plan There Are:

• NO yearly maximums
• NO deductibles
• NO claim forms
• NO pre-authorization needed
• NO pre-existing condition limitations
• Immediate eligibility and coverage
• Free consultations

Basic Savings Plans & Premiums

• Single: $399.00 annual cost
• Double*: $773.00 annual cost
• Family (3)*: $1147.00 annual cost
• Family (4)**: $1496.00 annual cost
• Additional members are $199.00 each

*The double Plan is for Parent/Child or Husband/Wife only.
**The Family Plan includes family members and children who are enrolled full time in college until the age of 23, or, children who are not enrolled full time in college until the age of 18.

Programs Exclusions and Limitations

This program is a discount plan, NOT a dental insurance plan. It cannot be used:

• In conjunction with another dental plan.
• For services or injuries covered under Workman’s Compensation, automobile, medical, or homeowner’s insurance.
• For treatment, which, in sole opinion of the treating dentist or doctor, lies outside the realm of their capability.
• For referrals or treatment by specialists.
• For hospitalization or hospital charges of any kind.
• All products.
• In conjunction with coupons or cash discounts.
• Plan is subject to change upon renewal.

There is a $50.00 charge for broken or cancelled appointments without 48 hours notice.

This plan is only honored at Associates for General Dentistry in Arlington Heights.

The Dental Assistance Savings Plan is not an insurance plan that can be used with any other dental office.

Program Guidelines

• Payment for Savings Plan must be paid before services are rendered.
• Premiums are non-refundable.
• No refunds will be given if the participant decides not to utilize the Dental Assistance Savings Plan program.
• Membership is valid for one year.
• There will be a reinstatement fee if your plan lapses.
• Patient’s portion of bill is due at time of service.