Keith + Associates Dental Advantage Plus Plan Terms and Conditions
The discounts associated with the Keith + Associates Private Dental Plan are available only through Keith + Associates Dental, DDS, PA.
Monthly membership fees are to be paid for a minimum twelve (12) month period and are non-refundable. Unless waived by the dentist, membership with automatically renew on the anniversary date and continue thereafter until cancelled, in writing, with a minimum 30-day notice.
Qualified dependents are defined as legal spouse or non-married children living in the household, under the age of 23. Any additional dependents after three (3) each will have an additional surcharge of $18 per month per dependent.
Fees and plan discounts are subject to change without notice.
Missed or broken appointments without 24-hour notice will be charge $50.
All member co-payments are due at time of service.
Membership in the Dental Plan may be terminated for abuse or failure to pay membership fees or properly billed services.
The Keith + Associates Private Dental Plan is administered solely by the dental office and may be discontinued at the end of any month with or without notice.
Keith + Associates Private Dental Plan benefits are limited to $2000 per each covered family member, per year.
Prophylaxis is limited to twice (2) every calendar year. A difficult prophylaxis (i.e. heavy smoker, neglected teeth, etc.) is subject to a $75 separate appointment charge or type II periodontal disease treatment charges.
Fluoride treatments are limited to twice (2) every calendar year.
By accepting the Dental Plan, your doctor will perform a comprehensive oral exam and members agree to follow prescribed maintenance program.
A non-surgical periodontal maintenance rider can be purchased, in addition to the base plan, for $20 per member per month.
All covered replacements are subject to the co-payment percentages as listed in the Schedule of Services and the private fee schedule of Keith + Associates Dental, DDS, PA.
Any dental procedure in progress or performed before or after a member’s eligibility period is excluded.
Any dental expense incurred if the dentist is unable to perform a procedure due to the member’s general health or physical condition is excluded.
Replacement of a satisfactory filling is excluded.
Replacement for lost or stolen dentures, partials or appliances is excluded.
Any dental procedure not listed as a covered service, including but not limited to, anesthesia, prescription medications, trauma to the mouth, emergency dental services, is excluded.
Treatment required due to hospital and medical charges or self-inflicted wounds of any kind are excluded.
Treatment to correct congenital, developmental, or medically induced dental disorders is excluded (i.e. TMJ).
Financing of co-payments from an outside source through Keith + Associates, DDS, PA (i.e. Care Credit) is excluded.
Dental Plan discounts for services provided in association with benefits from another source (i.e. workman’s comp) are excluded. Coordination of Keith + Associates Private Dental Plan benefits with other insurance plans is excluded.