All of the
schedule of fee are reduced fees-for-services performed by a participating
general dentist. The fee schedule is subject to change without notice. Any procedure not listed is available on a fee for service basis at a 20% discount from the participating provider's fee schedule. Consult with your participating dentist prior to beginning any treatment. Fees do not include lab costs which are the members responsibility. Some services, at the discretion of the general dentist, may need to be referred to a specialist (advanced degree). Please see "Additional Specialty Services."
This fee schedule represents the primary plan available in your state.
Additional Specialty Services
Any treatment provided by a participating specialist, if available, in Oral Surgery,
Orthodontics, Periodontics, Pedodontics or Endodontics will be charged at a 20%
reduction of participating specialist's fees for that particular case. Some specialists
may require a consultation visit before treatment is initiated. Discuss each case with
specialist prior to beginning any treatment.
Implants and some whitening procedures will not be
discounted by all participating CAREINGTON providers. Implants and some
whitening procedures will only be discounted if the participating CAREINGTON
provider has agreed to discount these procedures as part of their contract.
These services will be offered, when applicable, at a 15% discount off of the
provider's normal fee.
If the General Dentist's normal fee for any
procedure is less than the fee listed on the schedule, the dentist will charge
20% off of their normal fee for that procedure.
(1) Work in progress is not covered. (2) Work in progress after enrollment on
the dental plan must be completed before selecting another participating
dentist. (3) Any dental procedures performed by a non-participating dentist are
not covered. (4) We cannot guarantee the continued participation of any
dentist. If he/she leaves the plan, you will need to select another dentist.
(5) Not all types of dentists may be available in your area; you may have to
travel to receive care from a participating general dentist or specialist. (6)
Some providers may charge for missed or broken appointments with no prior
notice. (7) Please verify that the dentist is a participating provider when
scheduling your appointment. (8) Work in
progress prior to enrollment on the dental plan must be completed by the dentist
who started the work and is subject to no discount.
AGREEMENT AND AUTHORIZATION
I/We have read, understand and agree to the terms and conditions above. I authorize the Plan and/or assignees limited power of attorney to sign and charge my credit card according to the plan I have selected.
I further authorize the Plan the authority to charge my credit card for all future monthly renewals as they come due each month. I will notify the Plan in writing of my wish to cancel the membership 30 days in advance.
You may use the dental discount referral service according to the Member Information Guide and Membership Identification Card(s).
Your request for coverage authorizes the Plan to charge your credit card for the "initial down payment" to start your membership in the Plan Dental Care program. The Plan will then charge your credit card each month.
If you agree to these terms and conditions