Financial Information

MWDS PEDIATRIC ADVANTAGE PLAN FULL PLAN DISCLOSURE

1. TERMS AND CONDITIONS
   MWDS appreciates your membership and looks forward to servicing all your Pediatric needs.  We encourage you to take an active role in ensuring good dental health.  Most importantly, we encourage you to use your discounted benefits and we recommend scheduling a first appointment within (30) days of membership.  If you have questions about benefits, limitations or exclusions, you may call MWDS at (702) 957-1004.  Normal business hours are Monday-Friday 8 am to 5 pm. This is a discount plan. THIS IS NOT INSURANCE. By paying an annual membership fee to MWDS, members will be entitled to receive dental services at reduced rates.
2. WHEN MEMBERSHIP BEGINS
   Membership is effective the same day the enrollment application and membership fee are received.
   First Child (18 years or under) - $99
   Each Additional Family Child - $49
3. PLAN ELIGIBILITY
   As used in this Description, “Eligibility” means your children’s right to receive dental services at reduced rates. “Additional Family Member” means other children of your family.
4. CANCELLATION OF BENEFITS
   If the contract between the Plan and the Individual or Family is terminated by the Plan for non-payment of account balance, your membership will be terminated immediately.  Your membership may also be canceled for the following reasons:
   1. Failure to pay account balance.
   2. Fraud or deception in the use of the services or facilities of the Plan or knowingly permitting such fraud or deception by another such other good cause as agreed upon between the Plan and a group or you.
   3. Non-payment – If any member fails to make any past payment within (15) days after monthly notice to the member of the amount due, MWDS may terminate the Individual Contract effective immediately. These rights may only be reinstated by payment of the amounts due and by renewed application membership.  Services received after the effective date of membership termination will be charged to the member at MWDS’s usual fee.
   4. Furnishing incorrect or incomplete information: If the Member knowingly furnishes incorrect or incomplete information on the application, questionnaire, forms, or statements submitted to MWDS, the rights of the member and all additional family members may be terminated effective immediately.
   5. Misuse of Membership Card – If any Member permits the use of his or her Membership Card by any other person, or uses another person’s card, the card may be retained by MWDS, and all rights of the member and all additional family members who wrongfully permitted such use may be terminated.
   6. Behavior that is abusive to the extent that it threatens the safety of employees, providers, members, and/or other patients.
   Under no circumstances will your membership be terminated due to your health status or need for dental care.
5. DISENROLLMENT
   The MWDS Pediatric Advantage Plan term is twelve months/one year. You may disenroll from the plan at the end of the term of the contract period which is twelve months/one year.
6. RENEWAL PROVISIONS
   You can renew your plan for an additional year by paying an annual re-enrollment fee to MWDS before your initial eligibility terminates. MWDS will contact you about this at least thirty (30) days prior to the expiration of eligibility. Upon re-enrollment, you (and if applicable additional family members) will receive new membership cards. The same procedure will be used to re-enroll for succeeding years.
7. CANCELLATION OF SERVICES
   You may cancel your membership within (30) days of purchase for a refund. Enrollment costs and administration fees of $49 per card are non-refundable. If membership is canceled or refunded, all discounted services are void from the date of purchase.
8. MEMBER RIGHTS AND RESPONSIBILITIES
   As a Plan Member, you have the right to:
   1. Get appointments within a reasonable amount of time.
   2. Participate in candid discussions and decisions about your children’s dental care needs, including appropriate or medically necessary treatment options for their conditions(s), regardless of cost or regardless of whether the treatment is covered by the plan.
   3. Have your children’s records kept confidential. This means we will not share your dental care information without your written approval or unless it is required by law.
   4. Receive information about the MWDS Pediatric Advantage Plan, our services, and our providers.
9. YOUR RESPONSIBILITIES ARE TO:
   1. Understand your children’s dental problem(s) and participate in developing treatment goals, as much as possible, with your provider.
   2. Always present your Membership Card when receiving services.
   3. Ask questions about any dental condition and make certain that the explanations and instructions are understandable.
   4. Make and keep dental appointments. You should inform MWDS at least 24 hours in advance when an appointment must be rescheduled.
   5. Help MWDS maintain accurate and current medical/dental records by providing timely information regarding changes in address and contact information.
   6. Treat MWDS personnel and providers respectfully and courteously.
10. CONFIDENTIALLY OF MEDICAL/DENTAL RECORDS
    MWDS is committed to maintaining the confidentially and security of all members’ medical/dental information. MWDS may not disclose members’ medical/dental information without the member’s authorization unless required or permitted by law. Any disclosure of medical/dental information beyond the provisions of the law is prohibited. MWDS has instituted procedures to implement this confidentiality policy. These procedures ensure that an MWDS member’s medical/dental information is kept confidential.
11. NO COORDINATION OF BENEFITS WITH A SECONDARY INSURANCE
    Since MWDS does not provide insurance it does not coordinate benefits with any other dental insurance you or your family members may have. The MWDS Pediatric Advantage Plan is not supplemental insurance. It is a dental discount plan in which MWDS doctors have agreed to provide Plan members dental services at reduced fees. You may not use the MWDS Pediatric Advantage Plan in combination with your dental insurance plan for procedures or services covered by your insurance plan.
12. LIMITATIONS AND EXCLUSIONS:
    1. May not be combined with any other dental plan
    2. Does not include any orthodontic services.
    3. Treatment, which, in the sole opinion of the treating dentist or doctor, lies outside the realm of their capability.
    4. Hospitalization or hospital charges of any kind
    5. Cost of dental care which is covered under automobile medical
    6. Prescriptions and over-the-counter medications are not covered
    7. Only Pediatric procedures performed at MWDS are covered under this plan
    8. The Plan is a reduced fee dental plan: It is not insurance
    9. Dental services or appliances that are determined to not be reasonable and/or necessary for maintaining or improving the Member’s dental health as determined by the treating dentist
    10. Not to be combined with any other offers

If you complete and submit the membership form, you agree to be bound by all the terms and conditions in this description.