Program Guidelines

• Patient portion of bill is due at time of scheduling.
• Program cannot be used in conjunction with another dental plan or dental insurance.
• No refunds of premiums will be issued if participant decides not to utilize dental plan
• No membership card will be given. Your plan's effective date will be on file in our office.
• Program cannot be used at any office other than Hellertown Dental Group and its providers.
• Program cannot be used for referral to specialists or for hospital care. Plan cannot be used for costs of dental care which is covered under automobile medical.
• Program cannot be used for injuries covered under workers' compensation claim.
• Program cannot be used for treatment for which, in the sole opinion of our doctors, lies outside the realm of their capability.
• Family Plan includes parents and children under 26 years of age.

Hellertown Dental Group Advantage Program Membership Savings 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 Advantage Program membership, 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.
• 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 Advantage Program 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 Advantage Program savings
• All members of the same family account have the same anniversary date as the primary member
• Advantage Program 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)
• Advantage Program Participants cannot use insurance benefits or any other dental coverage in conjunction with their Advantage Program 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 Advantage Program Member Savings and interest free payment options will be customized for your repayment needs.
• Unused services, part of the Advantage Program membership program, 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 Advantage Program Membership 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 Advantage Program Benefits. All members of an Advantage Program 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.