Smile Saver Plan

Benefit Premiums

• Single Adult – $299
• Child (age 14 and under) – $279
• Additional family member (spouse or child) – $259

Coverage: Services Covered at 100%

• Comprehensive Exam (Initial Visit on New Patient)
• Periodic Exam (Two per year)
• Limited Oral Evaluation (Problem focused visit, One per year)
• Complete X-Rays Series or Panoramic X-Ray (One every three years)
• Bitewing X-Rays (one per year)
• Child Prophylaxis (two per year)
• Adult Prophylaxis (two per year)
• Fluoride (two per year, no age limit)

Coverage: Discounted Services

• Additional Oral Evaluations – 50% discount
• Additional Prophylaxis – 20% discount
• Sealants (no age limit) – 20% discount
• Fillings – 20% discount
• Periodontal treatment (Scaling/root planning and periodontal maintenance) – 20% discount
• Whitening (in office, at home and Kor whitening) – 15% discount
• Crown and Bridge – 15% discount
• Veneers – 15% discount
• Dentures and Partials – 15% discount
• Oral surgery – 15% discount
• Root canals – 15% discount
• Adjunctive Services (night guards, palliative treatments) – 15% discount
• Nitrous Oxide and Oral Conscious sedation – 10% discount
• Implants (implant and implant crown) – 10% discount
• Six month Smiles – 10% discount
• Invisalign – 10% discount
• In office purchases (Prevident, Clinpro, bleaching refills, Rotadent) – 5% discount

Programs Exclusions and Limitations

The program is a discount plan, not a dental insurance plan. It can only be used at Smiles by Design, PC. It may not be used:

• In conjunction with other dental insurance plans
• For services for injuries covered under workman’s compensation or automobile medical insurance
• For treatment that is beyond the scope of dentistry of the doctor
• For referrals to specialists
• Hospitalization or hospital charges of any kind

Program Guidelines

• After the initial sign up, there will be no additional paperwork or forms. All discounts will be applied on each visit.
• All annual premiums must be paid in advance and the annual plan is active for one (1) year from effective date.
• Plan premium and discounted services can be financed through Care Credit, if approved.
• Payment for your portion of the bill is due at time of services.
• This discount plan cannot be used in conjunction with other dental plans.
• Premiums are NON-REFUNDABLE or transferable, even if you decide not to use the discount plan.

BENEFITS

• Affordable
• Discounts on diagnostic, preventive and cosmetic services
• No yearly maximums, no deductibles
• No waiting periods
• No pre-preauthorization requirements or limitations of pre-existing conditions

This is a savings plan, not a dental insurance plan.