VIP 5 Star Discount Plan

It’s better than most commercial dental insurance.

Designed exclusively for those without dental insurance…to provide affordability and greater access to quality dental care.

BENEFITS:

With your Discount & Savings Plan there are :

1. No annual maximums
2. No deductibles
3. No claim forms
4. No waiting periods
5. No pre-existing condition exclusions or limitations
6. No pre-authorization requirements

Benefits Start Immediately

Enrollment

Annual Premium

Single Adult	$219
Dual (Couple)	$427
Family (3)	$624
Family (4)	$821

Each additional family member

$107

You will not receive a membership card. Your effective date will be on file with our office

Benefits:

What’s Covered

Treatment                           Discount

Diagnostic Services

Comprehensive Exams

(new patient-initial visit)	100%
Periodic Exam (2 per year)	100%
Limited (emergency) Exam	100%
Panoramic x ray (1 per year)	100%
Single x rays	100%

Preventative Services

Child Prophylaxis
2 cleanings per year	100%
Adult Prophylaxis
2 cleanings per year	100%
Additional routine cleanings	25%
Fluoride (2 per year children < 16)	100%
Sealants	25%

Other Procedures

Bleaching (whitening)	10%
Cosmetic Fillings	25%
Crowns	25%
Veneers	25%
Dentures & Partials	25%
Extractions	25%
Sealants	25%
Oral Surgery	25%
Root Canals	25%
Scaling & Root planning	25%
Periodontal Maintenance	50%

***If diagnosed with Periodontal disease

You will need 4 periodontal maintenance cleanings a year.

Terms of Usage Program and Limitations & Disclosures

This program is a discount plan-it is not a dental insurance. The plan is only available to individuals that don’t have dental insurance.  It cannot be used

1. In conjunction with any insurance plan
2. For services covered by workmans comp
3. For services covered by any other medical or dental insurance

Program Guidelines

1. This plan is honored only at VIP Dental Center in Palm Harbor Florida or Dental Emergency Room Clearwater
2. Patients’ portion of fee is due at time of service or treatment
3. No refunds of premiums will be issued at anytime if participant chooses not to utilize this discount plan.