In House Dental Savings Plan

In effort to help everyone achieve their dreams of perfect dental health, we have developed an “In-House” Dental Savings Plan exclusively for our patients, who do not have dental insurance. We are making enrollment in our in house dental savings plan available to all patients.

 

This is NOT dental insurance. Enrollment in our program gives you exclusive rates at our practice. It cannot be combined with dental insurance or any other discount plan. Members enrolled in a “Family” plan must all live in the same household.

 

Membership fees are due no later than the first Friday of the current calendar year.  We are more than happy to split your payments into 12 monthly installments. Monthly installments are subject to an 18% monthly finance fee. Coverage is effective for one calendar year. Members will be notified one month prior to membership renewal. Any missed payments will cancel membership and a $100 reactivation fee will be charged.

 

Membership Due:

1st and 2nd Family member: $400 per family member

1st two children (under age 14) : $350 per family member

Additional family members: an additional $185 per family member

 

Adult program: $400

Age 15 and over

(You save $250 on services)

Children’s program: $350

Until age 14

(You save $300 on services)

The Adult program includes:

• Adult Periodic Exams (2 per year)1

• Routine Cleanings (2 per year)2

• Check-up X-Rays (1 per year)

• 30% off all other dental procedures

The Children’s program includes:

• Child Periodic Exams (2 per year)

• Routine Cleanings (2 per year)

• Check-up X-Rays (1 per year)

• Fluoride Treatment (2 per year)

• 30% off all other dental procedures

Adult Periodontal Program: $590

(You save $198 on services)

Periodontal charting

Periodontal Maintenance (3 per year)

Adult Periodic Exams (2 per year)

Check –up X-Rays (1 per year)

30% off all other dental procedures

Benefits and Limitations

 

 

Benefits

• No Annual Deductible

• No Annual Maximums

• No Preauthorization’s required

• No waiting period or eligibility periods for major treatment

• No missing tooth clause restrictions or exclusions

• Cosmetic dentistry is included

• No restrictions on treatment

• No “Middle Man”

 

 

Limitations

• Annual enrollment fee for each family member is non-refundable

• Plan can be terminated at enrollees desertion, no refund will be provided

• Family members cannot be substituted in for another family member

• Your effective date is the date you sign up and your renewal date is the first day of the following year(Calendar year schedule)

• Rates are subject to change annually

• Membership is only valid at Esthetic & General Dentistry, therefore if you are referred to a Specialist, discounts offered by this program do not apply

• Current office promotions not included

• Services provided under this plan (exams, X-rays, cleanings, fluoride and discount) must occur within the year of enrollment and cannot be carried over to the next year

• Co-payment is due at time of service unless other plans have been arranged with the office

• A fee may be incurred for each broken appointment without a 48-hour notice

 

 

 

Please click below to download this form and fax to 301-309-2554 or email form to: info@drreginaldpettaway.com

 

"In House" Dental Savings Plan Form

(English Version)

"In House" Dental Savings Plan Form

(Spanish Version)

© 2015 Dr. Reginald Pettaway All rights reserved.
   Call Us: 301-217-9700

9850 Key West Avenue, Suite 308, Rockville, MD 20850

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