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In House Dental Membership Plan

No annual maximum or deductibles
No pre-authorizations
Immediate eligibility - No waiting periods
Significantly reduced dental fees
THREE!!! cleanings & exams per year

Annual Membership Dues

Adult Member - $799
Adult Perio Member - $899
Child Member - $499.99 (12 years old or younger at date of agreement, additional children will be
given a 15% family discount)

This is NOT dental insurance. Enrolling in our In-House Membership Plan gives you the opportunity to receive your dental treatment exclusively at our practice for reduced fees. It cannot be combined with dental insurance or other reduced fee dental plans. Please see our Terms and Limitations for more detailed information.

Treatment	Coverage Adjustment
Examinations
Comprehensive Exam (New Patient)	NOT COVERED
Periodic Exam (2 per year)	100%
Limited Oral Exam, Problem-Focused	100%
-
X-Rays/Diagnostic Films
Intraoral - Complete Series or Panorex x-rays	100%
Intraoral - Periapical film x-rays	100%
Bitewing x-rays (1 set per year)	100%
-
Preventative
Child Prophylaxis (Routine cleaning - 3 per year)	100%
Adult Prophylaxis (Routine cleaning - 3 per year)	100%
Perio Maintenance (3 cleanings per year)	100%
Perio Scale Treatment with OZONE included	10% OFF
Ozone Therapy discount for members ONLY	10% OFF
Major Services	10% OFF
Clear Aligner Therapy	$500 OFF

Terms and Limitations of the Plan

This is a dental discount plan and is NOT dental insurance. It cannot be combined with any other dental insurance
The effective date of this plan is the day you sign the agreement, and the automatic renewal date is 1 year after the agreement date.
Exams, x-rays, and cleanings, must be performed within the year of enrollment and cannot be carried over to the next year
Payment is due at the time of service for any work not covered 100% by this plan
This plan is only accepted at Mineola Dental Wellness. Therefore, if you are referred to a specialist, they will NOT offer these discounts.
Should there be dental treatment needed following any type of injury where a lawsuit, and therefore outside medical, care, disability, or workers comp type insurances are involved, this discount plan cannot be used.
This plan is non-transferrable. Family members cannot be substitutes for another family member.
This plan is non-refundable. No refunds are given if a patient chooses not to use their dental plan after the first 30 days following enrollment.
Eligible for dental services only, products are not included.
A $75 fee (based on length of appointment) may be incurred for each hygiene broken appointment and $100 for a doctor’s broken appointment without a 48-hour advance notice.
Rates are subject to change annually.
This Plan does NOT include ViVos Treatment