Description of Services and Membership Agreement
PLEASE READ THIS AGREEMENT CAREFULLY.
This Description of Services and Membership Agreement (“Agreement”) explains the terms, conditions, benefits, and limitations of the HFD Dental Membership Plan (“Plan”). By enrolling in the Plan, you acknowledge that you have read, understood, and agree to be bound by the terms of this Agreement.
The HFD Dental Membership Plan is a discount dental membership program that provides eligible members with reduced fees for covered dental services performed by participating providers. This Plan is not dental insurance and is not intended to replace dental insurance coverage.
If you have any questions regarding this Agreement or your membership, please contact us at:
This dental membership program is administered by HFDentistus.com, Inc., located at:
Questions regarding membership benefits, participating providers, billing, or eligibility may be directed to our Member Services Department during normal business hours.
The HFD Dental Membership Plan is a discount dental membership program that allows enrolled members to receive dental services at reduced fees from participating dentists.
THIS PLAN IS NOT INSURANCE.
The Plan does not pay dental claims, reimburse members or providers, or satisfy any health insurance requirement. Instead, members pay an annual membership fee in exchange for access to discounted dental services provided by participating dentists.
A complete schedule of discounted fees is provided in the Plan Fee Schedule and is incorporated into this Agreement.
For purposes of this Agreement, the following definitions apply:
Discounted fees are available only when services are provided by a Participating Dentist.
Dental services received from a dentist who does not participate in the HFD Dental Membership Plan are not eligible for Plan discounts.
Members are free to receive care from any participating provider within the Plan’s network.
To obtain an updated list of participating providers or assistance locating a participating dentist, contact Member Services at 1-888-800-4202 or visit the Plan website.
You may enroll in one of the following membership categories:
Coverage is limited to the individuals identified during enrollment and approved by the Plan Administrator.
To enroll, applicants must complete the official enrollment application and submit all required membership fees using an approved payment method.
After enrollment has been approved and payment has been processed, HFDentistus.com, Inc. will issue a Membership Identification Card for each covered member.
Membership benefits become effective upon issuance of the Membership Identification Card unless otherwise specified during enrollment.
Members must present their Membership Identification Card before receiving discounted services from a participating provider.
Membership remains active for twelve (12) consecutive months beginning on the effective date shown on the Member’s identification card.
Membership automatically expires at 11:59 p.m. on the expiration date unless renewed.
Eligibility for covered family members ends upon the earliest of:
A dependent child who becomes incapable of self-support because of a qualifying disability before reaching the limiting age may remain eligible, provided satisfactory documentation is submitted within sixty (60) days after notice of pending termination.
If additional documentation is required, HFDentistus.com, Inc. will notify the Member before eligibility is terminated.
Dental treatment that begins while membership is active may be completed at the applicable membership rates, provided treatment is completed according to the participating provider’s treatment plan.
Members may renew their membership for successive twelve (12)-month terms by paying the applicable annual renewal fee before the current membership expires.
Renewal notices will generally be provided at least thirty (30) days before expiration.
Renewal fees may differ from the initial enrollment fee.
Upon renewal, updated Membership Identification Cards will be issued.
Unless otherwise prohibited by law or this Agreement, renewal is available without additional underwriting or qualification requirements.
New members may cancel their membership within forty-five (45) days after receiving their Membership Identification Card(s) and receive a full refund of the annual membership fee, excluding any one-time processing fee, provided that:
Once any covered member receives services under the Plan, the membership becomes non-refundable.
After the initial cancellation period expires, membership fees are non-refundable.
Members may discontinue participation at the end of any membership term simply by choosing not to renew.
HFDentistus.com, Inc. reserves the right to terminate or refuse renewal only in cases involving fraud, abuse, misrepresentation, or misuse of membership benefits.
Membership fees are established by The HFDentistus.com and are subject to change upon renewal.
The current annual membership fee is as follows:
A one-time processing fee is also required at the time of initial enrollment.
All applicable fees must be paid using an approved payment method during enrollment or renewal.
Renewal fees for future membership periods may differ from the initial enrollment fee. Members will be notified of any fee changes before their renewal date.
The Plan provides Members with access to discounted fees for eligible dental services performed by participating Network Dentists.
A complete Fee Schedule identifying covered procedures and their corresponding discounted fees is provided separately and is incorporated into this Agreement by reference.
The Fee Schedule in effect at the time services are rendered will determine the amount payable by the Member.
The HFDentistus.com reserves the right to modify the Fee Schedule from time to time. Members will receive written notice of any changes at least thirty (30) days before a revised Fee Schedule becomes effective. Revised fees will apply only to dental services received on or after the effective date of the updated Fee Schedule.
This Plan has no deductibles, copayments, annual maximums, or claim forms.
Members are responsible for paying the participating Network Dentist directly for all dental services received at the discounted fees established under the current Fee Schedule.
Except for the applicable membership and processing fees, there are no additional charges imposed by The HFDentistus.com for participation in this Plan.
The following limitations and exclusions apply to this Plan:
Additional exclusions or limitations may apply as required by applicable law or as described in the current Fee Schedule.
Members are solely responsible for payment of all fees charged by a participating Network Dentist for services received under this Plan.
The participating Network Dentist will bill the Member directly using the discounted fees established under the current Fee Schedule.
The HFDentistus.com does not reimburse Members or providers for dental services and does not guarantee payment for any treatment rendered.
If The HFDentistus.com becomes financially responsible to a participating provider for any reason, the provider agrees not to seek payment from the Member for those amounts.
This Agreement provides access to discounted dental services only and does not constitute insurance coverage.
The HFDentistus.com maintains a formal grievance process to address complaints, disputes, or concerns regarding the administration of this Plan or services provided by participating Network Dentists.
Members may obtain a Grievance Form from a participating Network Dentist or submit a grievance through the Plan’s website.
Grievances may also be submitted in writing or by telephone.
A grievance must be submitted within one hundred eighty (180) days following the event giving rise to the complaint.
The HFDentistus.com will acknowledge receipt of a grievance within five (5) calendar days after it is received.
A written determination will generally be issued within thirty (30) days after receipt of all necessary information.
Additional information regarding the grievance process is available on the Plan’s website
Specialist dental services, including but not limited to endodontics, periodontics, orthodontics, and oral surgery, are not included under this Plan unless specifically listed in the current Fee Schedule.
At this time, The HFDentistus.com Discount Dental Plan does not provide discounted fees for specialist services through participating specialists. Members who require specialist treatment will be responsible for all fees charged by the specialist unless otherwise expressly provided in the Fee Schedule.
Participating Network Dentists generally maintain normal business hours, Monday through Friday.
Each participating Network Dentist is responsible for arranging appropriate emergency dental care for Members.
If emergency dental treatment is needed outside normal office hours, Members should contact their participating Network Dentist for instructions regarding after-hours care.
Members may also contact The HFDentistus.com at (888) 800-4202 for assistance with locating emergency dental care.
If a participating Network Dentist terminates participation in the Plan, The HFDentistus.com will make reasonable efforts to notify affected Members and assist them in locating another participating Network Dentist.
The HFDentistus.com will maintain information regarding participating Network Dentists who have terminated participation, are scheduled to terminate participation, or are otherwise unable to provide services.
Members may contact Customer Service at (888) 800-4202 to verify whether a dentist is currently participating in the Plan.
A participating Network Dentist who terminates participation in the Plan is contractually obligated to complete any dental procedures that were started before termination at the discounted fees applicable at the time treatment began.
If The HFDentistus.com ceases operations, participating Network Dentists will continue to honor discounted fees for enrolled Members and Eligible Family Members for the remainder of the active membership term, subject to applicable provider agreements.
This Plan is not insurance and does not coordinate benefits with any dental insurance policy or other third-party coverage.
Members who have separate dental insurance coverage should contact their insurance carrier to determine whether any reimbursement or benefits may be available for services received from participating providers.
The HFDentistus.com makes no representation regarding insurance reimbursement or coverage for services obtained through this Plan.
The HFDentistus.com is subject to the applicable provisions of California law governing discount dental plans and health care service plans, including Chapter 2.2 of Division 2 of the California Health and Safety Code and Chapter 1 of Title 28 of the California Code of Regulations.
Any provision required by applicable law to be included in this Agreement shall be deemed incorporated herein and shall be binding upon The HFDentistus.com whether or not expressly stated in this document.
The HFDentistus.com and participating Network Dentists are required by law to maintain the confidentiality of Members' personal health information.
Personal health information will not be disclosed except with the Member's authorization or as otherwise permitted or required by applicable law.
A statement describing The HFDentistus.com's policies and procedures regarding the confidentiality of medical and dental records is available upon request.
The following chart summarizes the major categories of dental services available through this Plan and the estimated average discount compared to usual and customary dental fees, as determined by the National Dental Advisory Service.
THIS SUMMARY IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY. MEMBERS SHOULD REFER TO THE CURRENT FEE SCHEDULE TO DETERMINE THE EXACT DISCOUNTED FEE FOR ANY PARTICULAR DENTAL SERVICE.
California law requires disclosure of the following information regarding deductibles, maximums, and coverage limitations under this Plan:
BY COMPLETING AND SUBMITTING THE ENROLLMENT FORM, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY ALL TERMS, CONDITIONS, LIMITATIONS, AND EXCLUSIONS CONTAINED IN THIS DESCRIPTION OF SERVICES, TERMS OF SERVICE, AND MEMBER AGREEMENT.