Gold Plan 15
Plan Information

A. Membership and Application
It's easy! To join, simply fill out the application. Everyone is able to sign up for this plan.

B. Your Effective Date
The Patriot Health membership operates on an annual basis. You are effective the day we receive your application and is valid for one year to the date of enrollment, which is opposite of what is done with dental insurance. Your application is usually processed within 48 hours of receipt.

C. How does the Plan Work?

  • Select any directory listed dentist you want. (Thousands available nationwide).
  • Present your Patriot Dental card and pay the dentist directly at special Patriot rates on dental procedures.
  • Enjoy the savings!

D. Choice of Provider
You must seek services by a participating Patriot Health provider to receive discounted dental services.

E. Specialty Care/Specialist Referrals
Participating Specialists will give up to a 25% discount off of their normal fees.

F. Emergency Dental Services
In case of an emergency, a Member should contact their usual network Provider. If he/she is unavailable, contact Patriot Health Member Services who will assist in locating another Provider.

G. Coordination of Services
Patriot Health can coordinate services with other insurance companies. In order to receive discounts from Patriot Health, you must see one of our Providers. After paying the reduced fee, you will need to file a claim form with your other insurance company for reimbursement.

H. Cancellation Policy
I am enrolling in the Patriot Health Dental Plan, which entitles me to utilize any dentist listed in the Directory. The rates, which a Directory Dentist will charge are the rates available to me as part of my enrollment in the Patriot Health Dental Plan. I have 30 days from my effective date to provide written cancellation and receive a full refund of membership fees. If the services have been used and a dentist has been visited the 30-day cancellation period is considered null and void. If you cancel, any payments made by you under the contract of sale, will be credited to your account within 48 hours of receiving your cancellation notice. Processing fees are specifically non-refundable.

I. Dental Directory Services (DDS), Terms and Conditions

  1. The dental services appearing in this schedule are available
    from general practitioners and specialists listed in the DDS Dental
    Directory. Any services that are not listed are available at a 25%
    discount from usual and customary fees charged by participating
    general practitioners and specialists, including pedodontics,
    prosthodontics and implantology.
  2. Aside from the Annual Check-up, additional exams, x-rays
    and consultations are available at a 25% discount at general
    practitioners. All exams, x-rays and consultations at all specialists
    are 25% of the dentist’s usual and customary fee. Invisalign
    braces are 25% of the dentist usual and customary fees.
  3. All participating providers may charge an OSHA sterilization
    fee per visit and a lab fee for crown and bridge work.
  4. Provider listings and/or fee schedules can be updated or changed
    without notice.
  5. Britesmile is not a covered procedure.
  6. It is the Member’s responsibility to verify that the dentist is
    a participating Provider for DDS before seeking any treatment.
    Any dental procedures performed by a non-participating dentist
    are not covered.
  7. The dollar amount specified for each procedure may not be
    the only cost incurred for a given treatment. Many treatments
    may require more than one dental procedure. Please consult
    with your DDS provider for a detailed treatment plan before
    beginning any dental work.
  8. DDS can not guarantee the continued participation of any
    dentist. If the dentist that you use leaves the plan, you will need
    to select another participating provider. Not all dental specialists
    are available in all areas.
  9. While participating DDS providers are professionally licensed
    in the state in which they practice, DDS does not guarantee the
    quality of service of the providers. Any quality of care concerns
    involving any participating provider should be directed to the
    DDS Provider Relations Department.

J. Grievance Procedures
Please call member services for all provider and service inquiries.

K. Disclaimer
This plan does not include all procedures, which might be provided by a general dentist. Any procedure delivered which is not listed on the fee schedule may cause additional cost to be incurred. These additional costs are the responsibility of the Member. The dollar amount specified adjacent to each procedure may not be the only cost incurred for a given treatment, because the treatment may require more than one dental procedure.