GOTTA SMILE DENTAL PLAN

IMPORTANT DISCLAIMER: THIS IS NOT DENTAL INSURANCE. Cannot be combined with other insurance or discount plans. The plan is not a qualified health plan under the Affordable Care Act and does not meet the minimum creditable coverage requirements under MGLC111M and 956 CMR 5.00. This Provider agrees, in exchange for your payment of agreed upon membership fees, to provide the Member with Covered Services. The Covered Services and a schedule of our current fees for the Covered Services will be provided upon request. If a patient presents with periodontal infection, a personalized treatment plan will be presented at an additional cost. If Provider offers a perio plan, it is strictly for preventive maintenance care. The membership plan will auto-renew each year on the renewal date. Patient may terminate and specific termination requirements will be found in the Membership Agreement. If a member cancels their plan, we require a one-year waiting period before reactivating. Covered Services not used during any one-year term will not be carried over to the next one-year renewal term, or be transferred to another member. Services will be provided at this practice only.