Dr. Jennifer W Gordona, DDS,LLC

2 REGULAR PERIODIC EXAMS

2 CLEANINGS

1 SET OF BITEWING X-RAYS

1 FULL MOUTH SERIES OF X-RAYS EVERY 5 YEARS (IF CURRENT PATIENTS ARE DUE, THIS WOULD REPLACE THE 1 SET OF BITEWING X-RAYS)

1 COMPREHENSIVE EXAM (FOR NEW PATIENTS ONLY), WHICH REPLACES 1 OF THE PERIODIC EXAMS

1 FLUORIDE APPLICATION PER ADULT PATIENT OR

2 FLUORIDE APPLICATIONS PER CHILD PATIENT

15% DISCOUNT ON ALL BASIC AND MAJOR SERVICES NEEDED (EX: FILLINGS, CROWNS, SIMPLE EXTRACTIONS).

20% DISCOUNT ON ANY LIMITED (EMERGENCY) EXAMS, PERIODONTAL SERVICES SUCH AS PERIODONTAL MAINTENANCE AND ANY ADDITIONAL X-RAYS.

1 ADULT MEMBERSHIP

$310.00

1 CHILD MEMBERSHIP

$265.00

2 ADULTS MEMBERSHIP

$600.00

IN ORDER TO OFFER THE SUBSTANTIAL PROCEDURE FEE COURTESIES AVAILABLE UNDER THE TERMS OF THIS PLAN, WE MUST ADHERE TO THE FOLLOWING PAYMENT POLICIES:

THE ONE YEAR MEMBERSHIP MUST BE PAID IN FULL AT THE TIME OF ENROLLMENT.

THE MEMBERSHIP WILL BE VALID FOR ONE YEAR FROM THE DATE THE ANNUAL FEE IS REMITTED

ALL TREATMENT FEES ARE DUE AND PAYABLE AT THE TIME SERVICE IS RENDERED

ALL FEES FOR TREATMENT REQUIRING MULTIPLE VISITS OR LAB FEES ARE DUE UPON THE FIRST VISIT.

PLAN IS NON-REFUNDABLE AND NON-TRANSFERRABLE.

PLAN IS SUBJECT TO CHANGE ANNUALLY.

EXCLUSIONS

PROCEDURE FEE COURTESIES OFFERED UNDER THIS PLAN SHALL NOT APPLY TO ANY TREATMENT ALREADY IN PROGRESS PRIOR TO ENROLLMENT IN THE PLAN AND MAY NOT BE COMBINED WITH DENTAL INSURANCE BENEFITS, ANY OTHER DISCOUNTS, PROMOTIONS OR OUTSIDE FINANCING PLANS (CARECREDIT, METLIFE, DELTA DENTAL, AETNA, CIGNA, SUPERIOR, AND UNITED CONCORDIA).
THIS IS NOT A DENTAL INSURANCE PLAN, BUT AN IN-HOUSE DISCOUNT PLAN. BENEFITS ARE LIMITED TO TREATMENT PROVIDED BY JENNIFER W. GORDONA DDS. JENNIFER W. GORDONA DDS, RESERVES THE RIGHT TO REFUSE TREATMENT AND/OR TERMINATE THIS MEMBERSHIP WITHOUT NOTICE, IF THE MEMBER'S ACCOUNT BECOMES DELIQUENT AT ANY TIME.
ALL OTHER GORDONA DENTAL, TERMS AND CONDITIONS APPLY.

OUR PLAN
Maximum Benefit
NO Maximum
Preventative Care
✔
Professional Cleanings for healthy gums and teeth
✔
Necessary XRays
✔
Cosmetic Services
✔
Unrestricted choice of dentist
✔
Courtesy Adjusted Fees
15%
No Pre-approval
✔
No Pre-existing condition exclusions
✔
No Deductibles
✔
No Waiting Periods
✔
No Claim Forms
✔
Continuous Open Enrollment
✔
TRADITIONAL INSURANCE
Maximum Benefit
$1000 - $2000
Preventative Care
✔
Professional Cleanings for healthy gums and teeth
✔
Necessary XRays
✔
Cosmetic Services
No
Unrestricted choice of dentist
No
Courtesy Adjusted Fees
No
No Pre-approval
No
No Pre-existing condition exclusions
No
No Deductibles
No
No Waiting Periods
No
No Claim Forms
No
Continuous Open Enrollment
No

OUR PLAN

TRADITIONAL INSURANCE

Maximum Benefit
NO Maximum
$1000 - $2000
Preventative Care
✔
✔
Professional Cleanings for healthy gums and teeth
✔
✔
Necessary XRays
✔
✔
Cosmetic Services
✔
No
Unrestricted choice of dentist
✔
No
Courtesy Adjusted Fees
15%
No
No Pre-approval
✔
No
No Pre-existing condition exclusions
✔
No
No Deductibles
✔
No
No Waiting Periods
✔
No
No Claim Forms
✔
No
Continuous Open Enrollment
✔
No

EXCLUSIONS

Maximum Benefit

Preventative Care

Professional Cleanings for healthy gums and teeth

Necessary XRays

Cosmetic Services

Unrestricted choice of dentist

Courtesy Adjusted Fees

No Pre-approval

No Pre-existing condition exclusions

No Deductibles

No Waiting Periods

No Claim Forms

Continuous Open Enrollment

Maximum Benefit

Preventative Care

Professional Cleanings for healthy gums and teeth

Necessary XRays

Cosmetic Services

Unrestricted choice of dentist

Courtesy Adjusted Fees

No Pre-approval

No Pre-existing condition exclusions

No Deductibles

No Waiting Periods

No Claim Forms

Continuous Open Enrollment

Maximum Benefit

Preventative Care

Professional Cleanings for healthy gums and teeth

Necessary XRays

Cosmetic Services

Unrestricted choice of dentist

Courtesy Adjusted Fees

No Pre-approval

No Pre-existing condition exclusions

No Deductibles

No Waiting Periods

No Claim Forms

Continuous Open Enrollment