*The plan begins on the sign-up date and will renew annually upon payment. Protect your family!
Included in “Smile for Life” Dental Discount Plan?
|2 Regular Dental Cleanings Per Year**|
|2 Oral Exams Per Year|
|1 Fluoride Treatment Per Year|
|Full-Mouth Series of X-Rays (Once Per 3 Years)|
|Bite-Wing X-Rays (Once Per Year)|
|Diagnostic Periapical X-Rays (As Needed)|
|Emergency Exam, Including Necessary X-Rays (During Normal Business Hours)|
|Oral Cancer Screening with Velscope (Once Per 3 Years)|
|2 Periodontal Maintenance Cleanings|
**If you are a patient that has had a history of Deep Cleanings (Periodontal Scaling &Root Planing) appointments in the past, you will be appointed for Periodontal Maintenance Cleanings which will be discounted at 50%–as noted above. Three or more yearly Periodontal Maintenance cleanings will receive a 15% discount.
Dental Procedures Receive a Member Discount of 15%:
- Fixed and Removable Prosthetics
- Composite Restorations
- Laminate Veneers
- Invisible Braces
- In Office Teeth Whitening
- Custom Tray Teeth Whitening
- Deep Cleaning (Periodontal Scaling &Root Planing)
*NO Deductibles, NO Hidden Fees, NO Yearly Maximums, NO Waiting Periods!
Dental Discount Plan Costs:
TYPE OF PLAN
Individual Plan (Ages 14 and Above)
Each Child under Age 14(with Adult Plan)
This program is a discount plan, not a dental insurance plan. It cannot be used for the following:
- TMJ and Bite Guard Therapy
- In conjunction with any other discount dental plan or dental insurance plan
- For treatment, which in the sole opinion of Dr. Obrochta, lies outside the realm of his expertise
- For referrals to specialists
- For hospitalization or hospital charges of any kind
- For costs of dental care or injuries which are covered under automobile or medical insurance or any other dental plan
- For dental treatment in progress
- This plan does not include dermal injections. (Radiesse, Juvederm, Belotero Balance, Xeomin, or Botox)
- There will be a $50 reinstatement fee if your plan lapses. (Please contact us two weeks prior to your renewal date to avoid a reinstatement fee.) It is the patient’s responsibility to maximize their benefits by arranging treatment within the 12 month membership period. If the appointments are not used, the member will not be entitled to a refund.
- Cannot be used in conjunction with another dental plan, automobile or medical insurance plan.
- Yearly participation fees are NON-REFUNDABLE; if a corporate Dental Insurance Plan is adopted through your workplace, we will pro-rate and refund your annual fee upon proof of insurance coverage.
- No refunds on premiums will be issued at any time if participant decides not to utilize the dental program.
- Not transferable.
- Patient’s portion of their bill is due on the day of treatment.
- No additional cash or credit card pre-pay discounts will apply and use of CareCredit® financing will reduce Membership discounts by 5% for individual treatments of less than $1,000.00.
- There will be a $50 Broken or Missed Appointment Fee without 24 hours notice, and being late for an appointment will count as a broken appointment.
- A second Broken or Missed Appointment without 24 hours notice nullifies participation in this program and all membership fees are forfeited.
The “Smile for Life” Plan is only honored at the Obrochta Center for Dental Health
For Further Information & Application
Please Contact: Obrochta Center for Dental Health at 727-321-4464