Dental Discount Plan

The Mortenson Family Dental Discount Plan is designed to provide affordability and greater access to quality dental care.You will receive
immediate, hassle-free and convenient eligibility. The dental services we offer are available at any Mortenson Family Dental Office, BracesBracesBraces, Oral & Facial Surgery Group or Kid’s Dentistree Locations.
This is a discount plan, not a dental insurance plan. The plan may be enhanced from time to time. Patient portion is due at the time of
service.
We make it simple for you to receive continuous care through our renewal process.

Visit our website for a  family, friendly, dental location near you. MortensonDental. com

Family. Friendly. Affordable.

With your  Dental Discount Plan there are:

No yearly maximums

No deductibles

No claim forms

No pre-authorization requirments

No pre-existing condition limitations

Immediate eligibility (no waiting periods)

Enrollment Fee

Single        $247.00

Dual          $459.00

Family*     $738.00

*Family Plan includes up to
6 members (Unmarried Children).
Additional family members may be
added for $115 each.
Plan year (12 month period)

This plan cannot be used in
conjunction with any other
promotion, offer or
insurance plan.

Member Discounts

Preventative Diagnostic 100%

Exams & X-Rays

• Comprehensive Exam per Member (one per member)
• Periodic Exams (2 per plan year)
• Limited Exam Problem Focus
(1 per plan year)
• Bitewings (1 per plan year)
• Complete Series or Panorex
(1 every 3 plan years)
• Individual lntraoral Periapicals
• Occlusal X-Rays (2 per plan year)

$5 Service Offerings

• Prophylaxis Cleaning-Adult or Child (2 per plan year)
• Fluoride-Adult or Child
(2 per plan year)

All Other Procedures

50% Discount
Sealants I Space Maintainers
25% Discount
All other services not otherwise specified
10% Discount
Orthodontics

Program Exclusions & Limitations

THIS PLAN IS NOT INSURANCE and is not intended to replace insurance.
This plan is not a Qualified Health Plan under the Affordable Care Act.
The plan provides discounts at certain health care providers for dental services. The range of discounts will vary depending on the type of service. The plan does not make payments directly to the providers of dental
services.
Plan members are obligated to pay for all health care services but will
receive a discount from those health care providers who have contracted with the discount medical plan organization, in accordance with the specific
pre-negotiated discounted fee schedule.
This program does not guarantee the quality of the services or procedures
offered by the providers. This program shall make available before purchase and upon request, a list of program providers, including their
address and specialty.

Enroll Today!

BY PHONE
888.380.0399

IN PERSON
Please visit any of our
conveniently located offices

BY MAIL
Mortenson Family Dental
Dental Discount Plan Administrator P.O. BOX 3082
Sioux City, IA 511 02

A complete and current listing of
all Mortenson Family Dental locations as well as applications are all available online:
www.mortensondental.com

Call (502) 244-9595
to make an appointment

Request an appointment