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- Contact a Dentex RepresentativePhone: 1(800)400-0613Email: info@dentex.net
The following information is Important Terms and Conditions regarding your membership with Dentex.
- This Agreement is between you ("Member") and Dentex Dental Plan, Inc. (“DENTEX”) and shall be effective on the date ("enrollment date") that DENTEX receives payment for all enrollment fees and forwards to you your Member ID Cards. MEMBER UNDERSTANDS THAT DENTEX PROVIDES DENTAL, HEALTH AND MEDICAL SAVINGS BENEFITS AND IS NOT AN INSURANCE POLICY, PLAN OR PROGRAM. DENTEX’s program makes available negotiated rate reductions for services and medical procedures rendered by providers of service listed in the Plan. DENTEX will NOT make any payments for services or any other kind of cost to either Members or providers of service on behalf of Members. DENTEX’s sole obligation under this Agreement is to administer Member's enrollment in the Plan.
- DENTEX will only provide Members with access to medical and healthcare PPO Network(s) as listed in the Plan. A limited directory of participating providers of service is provided to Member upon enrollment. The providers of service listed in the directory, DENTEX’s website or available from DENTEX’s Member Services Center are subject to addition, deletion or change at any time and without prior notice to member. It is the Member's responsibility to contact DENTEX to verify that a provider of service is a current participant in the Plan. Member may call DENTEX’s Member Services Center for current provider of service information.
- Member is solely responsible for all providers of service fees and costs. In order to access the Program's PPO Network(s) and the related benefit(s), the Member or the Member's family is responsible and must pay the balance for services due (the services due shall be the remaining balance after the savings discount benefit has been applied) to the provider of service promptly at the time of service and/or make acceptable payment arrangements with the provider of service. Payments or agreed payment arrangements with the provider of service must be made at the time of service.
- The actual savings that a Member may receive will vary and depend upon location and the nature of the specific procedure or service, including prescription drugs. Due to the usually higher expense associated with in-patient hospital visits, Member is required to contact DENTEX’s Member Services Center before admission for pre-admission procedures. Based on the hospital selected by Member from DENTEX’s list of available facilities and the hospital's total estimated cost to the member for the planned procedure, Member may be required to submit a pre-deposit to the hospital of $1,000.00 for each estimated scheduled day. If a deposit is required, Member's deposit to the hospital will be applied to the Member's total bill (or partially refunded depending upon the total amount of the final bill) at the end of the Member's hospitalization. Even though DENTEX will use its best efforts to provide savings benefits for all in-patient hospital visits, DENTEX can not guarantee or warrant that products, procedures, services and facilities are available in every medical situation and/or geographic location.
- Neither DENTEX nor any of its affiliates nor any PPO Network(s) shall be liable or responsible to make any payment to a medical provider or other provider of service used by a member of the DENTEX Plan. Neither DENTEX nor any of its affiliates nor any PPO Network(s) shall be liable for or held responsible for any refusal by a participating provider of service's refusal to accept the network rates offered under this Plan. DENTEX, its affiliates or any PPO Network(s) is NOT an insurer, guarantor or underwriter of a Member and is NOT responsible or liable for a Member's or Member's dependents' type, quality or cost of medical care or any other goods or services provided to Member or Member's dependents under this Plan.
- Participating medical providers of service are independent contractors. DENTEX, its affiliates and any PPO Network(s) are not liable for or responsible for the provision or omission of any medical services, treatments, consultations, diagnoses or advice that may be given or not given to a Member or a Member's dependents by a medical provider of service. DENTEX does NOT practice medicine and neither interferes with, participates in or is a part of the medical provider-patient relationship. The selection of a medical provider is the obligation of and the sole decision of the Member and such decision shall not be based upon the advice, credentialing or recommendation of DENTEX, its affiliates or any Provider Network(s).
- As part of its service to its Members, DENTEX may provide to providers of service under this Plan network rate information. If the disclosed information results in an underpayment to a medical provider for services rendered to a Member, Member agrees to pay to the medical provider the amount of any shortage within ten (10) days written notice to the affected member of the underpaid reimbursement. Likewise, if the information results in an overpayment to a medical provider for services rendered to a Member, DENTEX shall use its best efforts to assist the Member to collect the amount of such overpayment from the medical provider.
- Member's payments for participation in DENTEX’s Plan are due and payable in advance. DENTEX shall automatically deduct your payments on a recurring basis on or about each due date as authorized by you. Members may cancel their membership in DENTEX’s Plan any time after their initial yearly term is complete with 30 days written notice, and upon the return of the Member's ID cards. If a Member cancels his/her membership in writing within the first thirty (30) days of enrollment in the Plan, the Member may be eligible for a full refund if the Member's ID cards are returned to DENTEX.
- DENTEX reserves the right to terminate any enrollment or membership of any Member or Member's dependents or deny eligibility to any person for any reason, including for a Member's failure or refusal to pay a participating provider of service listed under the Plan or for nonpayment of a payment to DENTEX when due. If DENTEX receives a returned check, insufficient funds notice on bank draft or denial of a charge to a Member's credit card, DENTEX may terminate the affected Member's enrollment and membership effective immediately. If a Member applies for reinstatement of enrollment/membership that was terminated due to nonpayment, the member must pay as a condition of reinstatement a fee of $25.00 and 50% of total plan cost at the time of reinstatement.
- This Agreement constitutes the entire agreement between Member and DENTEX. THERE ARE NO WARRANTIES EXPRESS OR IMPLIED OTHER THAN EXPRESSLY STATED HEREIN. This Agreement may only be amended, changed or modified in writing. The laws of the State of Texas shall govern the interpretation, construction and enforcement of this Agreement. Any dispute arising from, out of, or relating to this Agreement shall be resolved by binding, non-appealable private arbitration, conducted in accordance with the rules of the American Arbitration Association. The appropriate offices of the American Arbitration Association located in Harris County, Texas, shall have exclusive jurisdiction and venue over all matters concerning this Agreement and will be the proper forums for adjudication of these matters. These provisions shall survive termination of this Agreement and Member's enrollment or membership in the Plan.
- Required State Disclosures
KY: This contract is not an insurance policy and is not protected by the Kentucky Life and Health Guaranty Association.
