The Dental Saving Plan  
Dental Savings Direct Care
Spokane Dental Providers

Disclosure Information

The Dental Saving Plan / Dental Savings Direct Care

Spokane Dental Providers is offering the DSP plan that offers reduced dental fees with an annual membership fee per year; and the DS-Direct Care is a patient centered/ dentist directed program that offers participants a maximum annual benefit with a monthly membership fee. These membership programs offer participants access to reduced dental fees with participating dentists at Liberty Lake Family Dentistry and Northpointe Family Dentistry.

This dental network is comprised of dentists who are independently practicing. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Notice of the change shall be provided in accordance with applicable state law. Spokane Dental Providers does not provide medical or dental care/treatment and is not responsible for outcomes. All dental care is the responsibility of the treating dentist, in consultation with the member. Selection of a member dentist is also the responsibility of the member and is not based on any representations by Spokane Dental Providers.

Dentists participating in the program network have agreed to make certain dental services and supplies available to participants on a "discounted service" basis. The term "discounted service" means a dental service that is available to a member at a reduced cost from fees normally charged by the dental provider and for which the member is solely financially responsible. Members can enroll in DSP for a $69 annual processing fee or in the DS-Direct Care Plan for a $39 or $59 monthly membership fee. Both programs are for routine services during regular office hours. A period of 6 months from date of enrollment is required before members are eligible for restorative or major discounted service fees. The registration fee is from Jan. to Dec. 2014, the membership fee will be pro-rated if signed up in the middle of the year. The Fee Schedule is posted and up dated on the Web Site; this includes the dental codes, names and fees for covered benefits. The Dental Savings Plan (DSP) is between 10-50% compared to Usual and Customary Fees. The Dental Saving Direct Care (DS-Direct Care) membership program allows members to choose between an annual benefit of $1000 or $1500 per year. The Dental Saving Direct Care (DS-Direct Care) is not an insurance plan, services and reduced fees are only available by member dentists at Liberty Lake Family Dentistry and Northpointe Family Dentistry. If referral to a Dental Specialist or another General Dentist is indicated the member will be subject to the referral dentist fees and office policies. Both policies cover routine services and are limited to procedures that the member dentist is trained or competent to perform and if for any reason he/she decides not to treat a particular condition and or patient, even if procedure is considered "routine" and is present in the fee schedule. Procedures recommend outside of fee schedule will be billed at usual and customary fees. All referred procedures and the associated fees are not a covered benefit to the program. All payments to dental providers are due and payable at the time of service, unless another payment arrangement is mutually agreed upon between the member and the treating dental provider. Participants shall be subject to the treating dental provider’s late payment and other office policies. THE PROGRAM IS NOT AN INSURANCE PLAN. There are no benefits payable to Participants, nor does Spokane Dental Providers compensate dentists for services they may render to participants. Spokane Dental Providers is not an insurer, guarantor or underwriter of any services provided under the program or of any payments to providers. Participants arrange for needed dental care directly with the member dentist. To remain eligible participants are required to pay member fees annually for DSP or monthly for DS-Direct Care and to abide by the DSP Wellness provision for the DSP plan. Payment for dental care is also arranged between the participant and the network dentist. You are responsible for paying the discounted fee directly to the provider at the time you receive services. Spokane Dental Providers shall in no event be liable for any payment to a provider accessed under the program or for the refusal of a provider to accept the discounted service rates.

Participants have the right to cancel membership in the Dental Savings Plan program within 30 days of registering; any paid membership fees paid for participation in this discount plan will be pro-rated and refunded.

Membership questions: Member Services at Spokane Dental Providers, 509-891-1020.

Participants may at any time submit a complaint either verbally by calling: 1-509-891-1020 or by mailing a written complaint to: Spokane Dental Providers, Customer Resolution Team, 1328 North Stanford Lane, Liberty Lake, WA, 99019.

Spokane Dental Providers is the brand name used for products and services provided by one or more of the group of subsidiary companies. The Dental Saving Plan and the Dental Saving Direct Care is not insurance and is offered by Spokane Dental Providers and member dentists. The program may not now, or in the future, be available. Spokane Dental Providers reserves the right to terminate the program in its entirety, without prior notice, for the next calendar year. I have read and understand the program.

Member Signature _________________________________________ Date_____________________

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