Loyalty Program

Main Content

Download Loyalty Plan Application here.

Dental Loyalty Plan Benefit Premiums

Plan	Total Annual Cost:
Single	$249.00 (savings of $154 per year)
Dual*	$470.00 (savings of $338 per year)
Family of 3**	$690.00 (savings of $519 per year)
Family of 4**	$880.00 (savings of $732 per year)
Each Additional	$110.00

* The dual plan is for Parent/Child or Husband/Wife only.
**The family plan includes family members and children under 18 or children who are enrolled in college full-time until age 26.

Coverage includes:

1. Comprehensive Exam (New patient/initial visit)	100%
2. Annual Exams	100%
3. Emergency Exam (and necessary xrays)	100%
4. Cleanings	100%
5. Oral cancer screenings	100%
6. Fluoride tooth desensitizing Treatments	100%
7. Bitewing X-rays	100%

Other Procedure Savings:

• 50% OFF Panorex or Full Mouth X-rays (every 3-5 yrs)
• 50% OFF Sealants
• 20% OFF Additional cleanings, Fillings, Core buildups, Oral Surgery, Root Canals, Crowns, Veneers, Periodontics, Dentures, Partials, Crown Implants, Night/Sport Guards

RULES & RESTRICTIONS

1. Can I use this for work I have already completed?
   Procedure Fee courtesies offered under Poulson Family DentalLoyalty plan will not apply to treatment  already initiated prior to enrollment in the plan.
2. Can I use the payment plan with my dental insurance?
   This plan is not to be combined with additional insurance plans, discounts, promotions, etc.
3. Is this an insurance plan?
   This is NOT an insurance plan. This is a savings plan offered to patients of
   Poulson Family Dental who do not have dental insurance.
4. Can I pay for just 3 months worth?
   Membership is for a minimum of 12 months - no less.
5. Can my child sign up alone?
   Membership is for adults and dependents under the age of 26.  Children may only be members with an adult primary membership.
6. What if you can’t fit me in when it’s convenient for me?
   It is the patient’s responsibility to schedule their free check-ups and it is encouraged that you plan well in
   advance. There are no refunds for an inability to schedule appointments within your effective membership dates.
7. What if I miss my free cleaning appointment?
   You are entitled to the benefits of your membership, but as with any other patient of our practice, failure to keep an appointment is subject to a $50 fee.

PAYMENT POLICY

* Your one-year membership begins the day of payment.
* The annual fee is a one-time payment that must be paid in full at the time of enrollment.
* Payment for services requiring multiple appointments is due at the first appointment.
* This plan and its benefits are non-transferable.
* All other financial policies, terms, and conditions of service of Poulson Family Dental.

Limitations & Exclusions:

* Treatment which, in sole opinion of our doctors, lies outside the realm of their capability.
* Demonstrated non-compliance with recommended course of treatment
* Services which in the opinion of the attending dentist, are neither necessary or recommended for the patient’s dental health
* Referrals to specialists and any costs associated with treatment needed at their office.
* Hospitalization or hospital charges of any kind
* Costs of dental care which are covered under automobile medical
* Treatment of injuries covered under workers’ compensation or Employer’s Liability laws.  Services which are provided without cost to the member by any municipality, county or other political subdivision
* Loss, damage or theft of dentures or crown/bridgework
* Services that cannot be performed because of the general health, physical or psychological limitations of the patient
* Any procedures of implantation or experimental procedures
* Treatment for malignancies, cysts or neoplasms or congenital malformations, except congenital anomaly of a tooth or teeth missing from birth
* Dispensing of drugs not normally supplied in a dental office
* Diagnosis and treatment of myofascial pain dysfunction syndrome