Plan Information

Smile Card Plan

A. Enrollment and Eligibility

Individuals who are 18 or old and their eligible dependents (unmarried children from birth to age 19; extended to age 26 if the child is a full-time student).

B. Your Effective Date

Plan effective dates are always the FIRST of the month. If the enrollment form and payment information are received by DentalInsurance.com by the 25th of the month, coverage will become effective on the FIRST of the following month. Incomplete enrollment forms, or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.

C. How does the Smile Card work?

As long as you meet the plan's general eligibility requirements and pay the applicable premium, your acceptance is automatic. This plan is not insurance and does not make payments directly to providers of service. The plan member is obligated to pay for all health care services and will receive a discount from providers who participate in the network. This plan provides discounts at certain health care providers for medical services.

D. Choice of Provider

The Smile Card is a discount plan that allows you to choose to obtain services from any licensed dentist of your choice within the network.

E. Specialty Care/Specialist Referrals

Specialty care partners offer plan members a 25% discount from their Usual and Customary fees for our Smile Card and Master Plans.

F. Emergency Dental Services

Emergency services can be utilized and the benefits will be applied based on the type of service needed.

G. Cancellation/Termination of Policy

  1. Subscriber’s coverage will cease and terminate upon the occurrence of any of the following events:
    1. The end of the period for which required Premiums are due but not paid;
    2. The date that a Dependent no longer satisfies the definition of Dependent contained herein;
    3. Subscriber leaves the geographical service area of Plan with the intent to relocate or establish a new residence on a permanent basis outside of Plans geographical area;
    4. Voluntary termination. (Premium not refundable)
  2. In addition, if after forty-five (45) days written notice of cancellation, coverage will terminate:
    1. After reasonable efforts have been made by all parties to establish a working dentist/patient relationship and have been unsuccessful;
    2. Because of fraud, material misrepresentation, misuse of dental services, facilities or membership privileges;
    3. Because of misuse of documents provided as evidence of coverage available to Subscriber through Plan;
    4. Upon Subscriber furnishing to Plan, by Subscriber, incorrect or incomplete information for the purpose of fraudulently obtaining services.
  3. This is a one (1) year policy.
    Termination request must be submitted in writing 30 days prior to end of contract. Contract will renew automatically if notification is not submitted.

 

H. Exclusions/Limitations

This plan is not insurance and does not make payments directly to providers of service. The plan member is obligated to pay for all health care services and will receive a discount from providers who participate in the network. Click here to see full Discount Fee Schedule.

I. Grievance Procedures

If you or one of your eligible dependents has a complaint you may issue a Complaint by calling Argus Dental’s Member Services.

J. Disclaimer

This is a general summary of the features of the Smile Card. When you purchase the plan you will receive a Certificate of Insurance that details your rights and obligations, as well as those of the insurance company.

This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exceptions and limitations is contained in the Certificate of Insurance.