Benefit Premium
Plan Cost Total Annual Single $220 Each Additional Member $200 Each Plan includes:
- 1 Comprehensive & 1 Periodic exam (or) 2 Periodic exams -OR-
- 1 Limited exam with a Periodic or Comprehensive exam
(Max of 2 exams – any combination) - Full mouth X-rays – (Unlimited
X-rays as needed)
**The Family Plan includes family members of the same household and dependents who are enrolled full-time in high school or college until the age of 23, or dependents who are not enrolled full-time in high school or college until the age of 18. The Savings Plan will be effective on the date which the premium is paid in full, and will remain in effect for one year from the effective date.
Coverage Treatment Discount
Diagonostics/ X-rays
Comprehensive Exam* (New Patient/Initial Visit) - 100%
Periodic Exam (2x/plan year)* - 100%
Limited exam (1x/plan year)* - 100%
X-rays (pano, bite-wings, periapicals, no frequency limits) - 100%
PREVENTATIVE
Child/Adult trophy (cleaning, 2x/plan year) - 30%
Fluoride (2x/plan year, no age limit) - 100%
ALL OTHER PROCEDURES
- Fillings + Core Buildups - 30%
- Periodontics - 25%
- Crowns - 25%
- Veneers - 25%
- Dentures/Partials - 25%
- Oral Surgery - 25%
- IV Sedation - 25%
- Root Canals - 25%
- Implants - 25%
*Patients allowed 2 exams per year (any type)
Exclusions and Limitations
The program is a discount plan, not a dental insurance plan. It cannot be used: n conjunction with another dental plan For services related to injuries covered under workman’s compensation For referrals to specialists For costs of dental care which is covered under automobile coverage Any treatment that the Dentist believes it outside of their capability Premiums are non-refundable.
Savings Plan is non-transferable.
Care Credit cannot be used to pay the premium, but can be used for services. Allotted Services that are not used during the plan year will not roll over into the next year (i.e. 2 exams per year). This savings plan is only honored at Hometown Family Dental Centers Our regular appointment and financial policy still applies.
