Membership Savings Plan
The following is a description of the Membership Savings Plan available to you and your family through Avon Family and Cosmetic Dentistry, LLC. This is a description of the plan, your rights under this plan, and if you choose to enroll, it is your contract with Avon Family and Cosmetic Dentistry, LLC. You should read this carefully. If you have any questions about this description, please call Avon Family and Cosmetic Dentistry, LLC at 860.674.0707.
The full name of the plan: Adult Membership Savings Plan
Annual Fee: $475 (Renewal price may vary and will be communicated to you at the time of renewal)
Auto-Renewal: Annual Automatic Renewal unless canceled. (30-day cancellation period after auto-renewal as long as benefits are not utilized. No refund after 30 days).
Our email address is: email@example.com
Our Phone number is 860.674.0707.
Please contact us at above email or phone to make changes to your membership plan.
This is a discount dental plan. The Membership Savings Plan is not an insurance product. This plan cannot be used in conjunction with any dental insurance plan, in-office discounts, (such as senior discounts), or financing plan (such as CareCredit). By paying an annual enrollment fee to the Membership Savings Plan, you will be entitled to receive the following dental services during each enrollment period:
Preventative Services included in our Membership Savings Plan:
- 2 regular examinations
- 2 cleanings (non-periodontal based)
- 2 oral cancer screenings
- 1 Fluoride treatment
- Any necessary radiographs (as deemed necessary by the doctors)
- 1 Emergency Visit
Other Services Provided at a Discounted Fee in the Membership Savings Plan:
- 15% off additional cleanings, sealants, fillings, core buildups, extractions, root canals, crowns, veneers, teeth whitening, and other dental procedures completed at our office
- $500 off Invisalign treatments
All services provided at discounted fees will be due at the time of service. All services are provided by scheduled appointments only.
The Membership Savings Plan does not include:
- Treatment, which is the sole opinion of the doctor, lies outside of the realm of their capabilities
- Fees when referred to a specialist for care
- Hospitalizations or hospital charges of any kind
- Costs of dental care which are covered under medical insurance
- Services required to repair dental injuries covered under Workman’s Compensation
Once you have read through this description, please sign and date on the last page to enroll in this program. You may either send the completed form with payment to Avon Family and Cosmetic Dentistry, LLC, or give it to a member of the front desk staff along with your payment. Annual membership fees can be made by cash, check, debit or credit card and they are NON-REFUNDABLE.
Once your Enrollment Form and fees are received and processed, you will receive an E-mail with membership details. Please save a copy of that email as proof of eligibility. Eligibility begins when we receive your annual fee. You may be required to present your email proof of eligibility, if requested, at our office before you receive treatment. If you are applying for the Membership Savings Plan in the office, once payment is received, discounts could be immediately applied.
Your right to receive services will continue for one year from the time Avon Family and Cosmetic Dentistry receives your initial enrollment fee. The termination date will appear on your eligibility email and will end at midnight on that date. Upon the member's request, there is an initial 30-day refund policy, and the initial enrollment fee will be refunded if no services have been availed by the member. No refunds of the annual enrollment fee will be issued at any time after 30 days or upon receiving any services at our office. If paid by credit card, the actual merchant charge will be deducted from your refund which is usually between 2-3% of the total charge.
Your right to receive services at the discounted fees described in this plan will end at the expiration of your one-year term unless you re-enroll before the expiration date. If you cancel and prefer to re-enroll within the next 365 days, you will have to begin the membership plan from the termination date and not the current date. All procedures must be completed prior to the termination date to receive the discounts if you prefer not to renew the membership. If you prefer to renew the membership but not from the last termination date, you can pay a re-activation fee and start the membership from the current date. The re-activation fee currently is assessed at $100 and is subject to change. Please ask about our current re-activation fee prior to renewing your membership plan.
You can renew your right to receive discounted fee services for an additional year by paying an annual re-enrollment fee to Avon Family and Cosmetic Dentistry before your initial eligibility terminates. The annual re-enrollment fee maybe different from the initial annual enrollment fees. You will be notified of what the applicable fee is on your renewal notice.
The same procedure will be used to re-enroll for the following years. Other than payment of the required fee, there are no conditions or restrictions on your right to re-enroll.
You can terminate your eligibility after any one-year period simply by choosing not to re-enroll. Avon Family and Cosmetic Dentistry, LLC or its successors cannot cancel your enrollment in the middle of any one-year period even if you are unable to use this plan for any reason.
Membership Savings Plan/s can be transferred/re-assigned or sold to the successor/s of Avon Family and Cosmetic Dentistry, LLC without prior notice to the member.
By signing below, I acknowledge that I have read this membership plan contract and fully understand this contract.