Required Legal Statements And Other Stuff
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This Plan IS NOT Insurance and IT IS NOT intended to replace insurance.
DISCLOSURE:
This plan is NOT insurance.and IS NOT intended to replace insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act.
This is your agreement as Cardholder (”Member”) with Savon Professional Services Inc., and Savon Dental Plan (a “discount medical plan organization,” “DMPO”). It is effective on the date of acceptance of Member’s application for enrollment in Savon Dental Plan (”Savon”) and for the period of your plan.
USE OF DENTISTS:
Savon shall provide Member with a listing of participating providers. Member shall excuse Savon from any liability for errors in such listings. Providers are subject to change without notice. Member is responsible for choice of provider, verification that the provider is a current participant. Members may change dental facilities as necessary and shall notify SAVON each time a dental facility change is made.
Dental facilities may not be available in all areas and services are limited to the geographical areas where providers are located.
REIMBURSEMENTS:
Savon is not an insurance company and will not reimburse any member or doctor for any fees listed on the schedule of benefits, prescriptions or fees that are not listed.
No portion of any provider’s fee will be reimbursed or otherwise paid by Savon.
PAYMENT FOR SERVICES:
Member is solely responsible for payment for services provided. If member uses a Network Preferred Provider, member shall be charged the Savon fee for their zone. If member uses a Network provider, member is entitled to a discount of 10 to 50% from the provider’s usual fee. Actual savings will vary depending upon your location and the specific products or services purchased.
Member must use a Network Preferred or Network Participating Provider to receive a discount.
PLAN USAGE:
Savon discounts cannot be used in conjunction with any other network based program. Depending on the size of plan you purchased, only you or your immediate family (spouse, significant other and children), living in the same home, may use the plan. Member may add or remove family members by calling the toll free Customer Care number shown on the membership I.D. card. The price of the plan will be adjusted accordingly.
Plans Are Available Only In States With Network Preferred Or Network Participating Providers.
PROVIDER CREDENTIALING:
Although Savon screens providers to ensure appropriate credentials and qualifications to provide goods and services, Savon does not guarantees and is not responsible for the quality of such service or product purchased by Member.
MEMBERSHIP FEES:
Payment of membership fee is made by the billing source you authorized in accordance with the payment terms to which you agreed. Membership fee is protected in accordance with our membership rate guarantee. At least 30 days prior to expiration, Member will be billed for renewal. Membership in Savon is transferable one (1) time.
LIFE AND HEALTH GUARANTY ASSOCIATION:
This contract is not an insurance policy and is not protected by any Life and Health Guaranty Association.
GENERAL COMPLAINT PROCEDURE:
Complaints of any nature may be filed with Savon at P.O. Box 54277, Phoenix, AZ 85078-4277 or via email at CustomerService@SavonDentalPlan.com. Complaints will be acknowledged in writing within 5 business days and, under normal circumstances, be resolved in writing to you within 30 calendar days.
OH & SD - If you are not happy with the results from your complaint, you may contact the Department of Insurance for your State.
TX - Regulated by the Texas Department of Licensing and Regulation, PO Box 12157, Austin, TX 78711 telephone 1-800-803-9202 or 512-463-6599, www.license.state.tx.us.
TERMINATION & CANCELLATION:
You may terminate this agreement and your membership at any time by calling us at the toll free number on your membership card or in writing at P.O. Box 54277, Phoenix, AZ 85078-4277, however
Savon Dental Plan® has a "No Refund" policy except in the following states.
MD, ND, OK, SC, SD,TX, AR and TN residents only: Within the first 30 days of the effective date of this agreement, you may return your membership material and cancel your plan for a full refund of your membership fees minus the non-refundable processing fee. If you utilized the plan during the first 30 days and you cancel your plan, you will be billed the difference between the UCR fee and the current fee schedule prior to the cancellation. Refunds on cancellation requests may take 4-6 weeks. Plans written on a monthly basis require a one (1) commitment and are not refundable under any circumstances.
All fees are considered earned upon receipt and no refund will be considered except as stated above.
All fees paid for plan renewal (continued membership) are considered earned upon receipt and are not refundable.
GOVERNING LAW & ARBITRATION:
This agreement and its interpretation and enforcement shall be controlled by the laws of the State of Arizona. Any dispute arising from or related to this agreement shall be resolved by private binding arbitration conducted in accordance with the Rules of American Arbitration Association (A.A.A.) in Phoenix, Arizona, unless required by Member’s state law to resolve in a different location.
FL - Interpretation and enforcement shall be controlled by the laws of the State of Florida. Disputes may be resolved by voluntary private arbitration and conducted in accordance with the Rules of the A.A.A. in the local jurisdiction.
MT - Interpretation and enforcement shall be controlled by the laws of the State of Montana. Disputes may be resolved by voluntary private arbitration and conducted in accordance with the Rules of the A.A.A. in the State of Montana.
The above provisions shall survive the termination of this agreement and its interpretation shall be subject to the Federal Arbitration Act.
SD - South Dakota residents: If you cancel this plan you are not obligated to make any further payments under the plan, nor are you entitled to any benefits under the plan for any period of time after the last month for which payment has been made.
CANCELLING APPOINTMENTS:
If you have an appointment and you fail to keep it or cancel it 24 hours prior to the appointment
YOU WILL BE charged a missed appointment fee. In accordance with your fee schedule this fee is charged for each 15 minutes of appointment time that has been allocated. I.E. (45 minute appointment missed = missed appointment fee x 3).
