Premium Membership Plan

No Dental Insurance? No Problem!

The Mesa Dental Premium Membership Plan is an annual savings plan for families and individuals that allow all members to receive premium dental services at greatly reduced prices. Unlike conventional insurance plans, with the Mesa Dental Membership Plan, there are no deductibles, no annual spending limits, and no waiting periods to begin treatment. The Mesa Dental Membership Plan benefits coverage begins immediately upon plan enrollment.

Mesa Dental Premium Membership Plan is a discount dental program, not dental insurance. This program is offered to our patients who do not have dental coverage.

The Mesa Dental Membership Plan is an alternative for businesses, families or individuals, who want excellent dental health coverage without the barriers of a traditional dental insurance:

– No waiting periods

– No annual maximums

– No pre-existing conditions exclusions
- No hassle dealing with insurance companies

SERVICES INCLUDED IN THE YEARLY MEMBERSHIP: (Up to a $595 value)

• All necessary x-rays including a full mouth series.
• Two Periodic Examinations per year.
• Two Routine Oral Prophylaxis per year (prophylaxis only, not advanced hygiene services such as scaling and root planning, or Perio maintenance treatments.)

REDUCED FEES:

All dental services are offered at 20% less than Mesa Dental’s normal office fees (UCR). Payment for the above services is due at the time of service, and all payments are made directly to: Mesa Dental

SERVICES OFFERED

Mesa Dental Premium Membership Plan offers members a comprehensive dental package of dental benefits. The plan covers Diagnostic, Preventive, Restorative and Cosmetic Services.

ENROLLMENT FEES:

Membership dues are to be paid for a minimum of a twelve (12) month period and are non-refundable once any treatment or service has been performed.

*These are a few of the most common procedures. Your complete treatment plan, including fees and discounts, will be discussed prior to commencement of treatment

ELIGIBILITY:
 Everyone is qualified to apply for our Mesa Dental Membership Plan. Participants are eligible upon payment of the enrollment fee. This plan is administered solely by this dental office and may be discontinued at the end of any month, with or without notice.

Membership in the Dental Plan may be terminated if the member misses multiple Appointments, or for abuse and failure to pay membership fees or properly billed treatment.

PLAN LIMITATIONS AND EXCLUSIONS:

• Dental services not provided by our practice are not covered by this plan, even if they are recommended by our office, such as referrals to specialists.
• Any dental procedures in progress or performed before or after a member’s eligibility period is excluded.
• Any dental services provided to the member by the state, county, or municipal agencies, or dental services provided without cost to the member is excluded.
• Dental plan discounts for dental services provided in association with benefits received from an alternate source (i.e. Worker’s Compensation) is excluded.
• Our plan is offered to patients who do not have dental insurance coverage.

CANCELLATION:
 Unless waived by the dentist, membership will automatically renew on the anniversary date and will continue thereafter until canceled in writing. Cancellation should be sent 30 days prior to the expected date of cancellation.

If the plan is canceled by the dentist, a pro-rated portion of the membership fee will be refunded to the member if account is paid up to date.