Renewal Conditions: By joining, you are authorizing the Plan to bill your credit card or checking account. This charge shall renew until you notify the Plan in writing of its cancellation. By joining you indicate you have read the terms and conditions of the Plan. This plan will automatically renew at the end of you membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.

Termination Conditions: MERCHANT and the Plan reserve the right to terminate plan members from its plan for any reason, including non-payment. If the Plan terminates the program or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.

Description of Services: Please see the product detail page for a specific description of the plan that you have purchased.

Limitations, Exclusions & Exceptions: This plan is offered by MERCHANT. The Plan is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by the Plan. The Plan is not licensed to provide and does not provide medical services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time the Plan may substitute a provider network at its sole discretion. The Plan cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by the Plan are solely responsible for the professional advice and treatment rendered to members and the Plan disclaims any liability with respect to such matters.

Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to MERCHANT Address. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state consumer department.

Hellertown Dental Group Wellness Plan Limitations and Exclusions:

• Demonstrated non-compliance with patient's recommended course of treatment
• If you have Periodontal Disease, a Periodontal Maintenance will be performed as a 'simple' cleaning will not be sufficient for your oral health care needs. The simple cleaning benefit, included in the Standard Wellness Plan, will be applied to the costs of your Periodontal Maintenance cleanings two times in your plan year. The difference in cleaning fees will be your responsibility at the time of service. Each additional recall, we will offer you a savings on your periodontal maintenance cleanings when you pay for them in full at time of service. Or you may choose the HDG Perio Wellness Plan or another appropriate plan to site your oral care needs.
• Restoration, splints or other appliances used to increase vertical dimension or restore occlusion
• Oral surgery requiring the setting of fractures or dislocations
• Treatment of malignancies, cysts or neoplasms
• Congenital malformations, except congenital anomaly of a tooth or teeth covered from birth
• Dispensing of drugs not normally supplied in our dental office
• Hospital benefits for any dental procedure
• Loss or theft of dentures or bridgework
• Implantation
• Experimental procedures
• Services for injuries or conditions which are covered under Worker's Compensation or Employer's Liability laws
• Services which are provided without cost to the member by any municipality, county or other political subdivision
• General anesthesia
• Services that cannot be performed because of the general health, physical or psychological limitations of the patient
• Periodontics, endodontics, oral surgery or pedodontics requiring the services of a nonparticipating dentist/specialist outside of our office
• Those procedures requiring appliances or restorations that are necessary for full mouth rehabilitation, or to alter, restore or maintain occlusion, including, with limitation, treatment of disturbances of the temporomandibular joint
• They are not transferable to other HDG Wellness Plan members
• Diagnosis and treatment of myofacial pain dysfunction syndrome
• Procedures performed in the hospital
• Membership fees are due payable, in full, at time of services and are not refundable when any treatment provided equals or exceeds the costs of the membership fee
• All payment for services are due in full at time of services in order to receive HDG Wellness Plan savings
• All members of the same family account have the same anniversary date as the primary member
• HDG Wellness Plan is offered to patients without dental insurance and to those without PPO based insurance program(s) (please ask if you are unsure if you are on a PPO based carrier)
• HDG Wellness Plan Participants cannot use insurance benefits or any other dental coverage in conjunction with their Wellness Plan membership
• Interest-free payment plans duration may be available upon request with approved credit.
• Repayment duration is based on service totals and procedural type. If you choose to use a repayment plan, your HDG Wellness Plan Member Savings and interest free payment options will be customized for your repayment needs.
• Unused services, part of the HDG Wellness Plan, are not transferable to other patients, to other offices and do not roll over to the next membership year
• A 48 hour notice is required to reschedule and/or cancel appointments or we reserve the option to bill you 25% of the scheduled treatment amount for your missed appointment

Eligible family members include spouse and dependent children to age 26. All HDG Wellness Plans fees are due payable at the time of registration are non-refundable. Plan duration is for one year from registration date. All patient portions for services received are due at the time of services in order to receive Wellness Plan Benefits. All members of an HGD Wellness Plan family account will have the same anniversary date as the primary member. A missed appointment fee of 25% of treatment total will be charged for all missed dental appointments. Please notify our office at least 48 hours in advance if you must change your appointment.

Please Note: The HDG Wellness Plans are subject to Program Guidelines listed here in the description and is offered to patients without dental insurance and to those without PPO based insurance program(s).