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MEMBERSHIP AGREEMENT
Discount Plan Organization:
Metrodent
303 Merrick Road, Suite 300, Lynbrook, NY 11563
To add a family member to your plan, contact MetrodentUSA at 844-638-3368.
Group Code: V225
Group Name: MetrodentUSA
Member ID:
Member Name & Address: [FIRST NAME M LASTNAME
123 ANY STREET APT1 ANY CITY, TX 12345]
Effective Date: [ ]
Term: [ ]
Total Fees:
Classification: [ ]
Mode of Payment: [ ]
Periodic Charge: [ ]
Processing Fee: $0
Renewal Conditions: By joining a plan, you are authorizing Metrodent to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Metrodent in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.
Termination Conditions: Metrodent reserves the right to terminate plan members from its plan for any reason, including non-payment. If Metrodent terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.
Cancellation Conditions: You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Metrodent will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Metrodent, 303 Merrick Road, Lynbrook, NY 11563 or fax to 877-414-4069. You may also submit cancellation requests by email: info@metrodentusa.com. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period.
Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.
Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Metrodent. Metrodent is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by Metrodent. Metrodent is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Metrodent cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Metrodent are solely responsible for the professional advice and treatment rendered to members and Metrodent disclaims any liability with respect to such matters.
Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Metrodent, 303 Merrick Road, Lynbrook, NY 11563. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department.
Metrodent
303 Merrick Road, Suite 300, Lynbrook, NY 11563
To add a family member to your plan, contact MetrodentUSA at 844-638-3368.
Group Code: V225
Group Name: MetrodentUSA
Member ID:
Member Name & Address: [FIRST NAME M LASTNAME
123 ANY STREET APT1 ANY CITY, TX 12345]
Effective Date: [ ]
Term: [ ]
Total Fees:
Classification: [ ]
Mode of Payment: [ ]
Periodic Charge: [ ]
Processing Fee: $0
Renewal Conditions: By joining a plan, you are authorizing Metrodent to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Metrodent in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.
Termination Conditions: Metrodent reserves the right to terminate plan members from its plan for any reason, including non-payment. If Metrodent terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.
Cancellation Conditions: You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Metrodent will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Metrodent, 303 Merrick Road, Lynbrook, NY 11563 or fax to 877-414-4069. You may also submit cancellation requests by email: info@metrodentusa.com. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period.
Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.
Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Metrodent. Metrodent is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by Metrodent. Metrodent is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Metrodent cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Metrodent are solely responsible for the professional advice and treatment rendered to members and Metrodent disclaims any liability with respect to such matters.
Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Metrodent, 303 Merrick Road, Lynbrook, NY 11563. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department.
MEMBERSHIP AGREEMENT
Discount Plan Organization:
Careington International Corporation (Careington)
7400 Gaylord Parkway Frisco, TX 75034
To add a family member to your plan, contact MetrodentUSA at 844-638-3368.
Group Code: V226
Group Name: MetrodentCare
Member ID:
Member Name & Address: [FIRST NAME M LASTNAME
123 ANY STREET APT1 ANY CITY, TX 12345]
Effective Date: [ ]
Term: [ ]
Total Fees:
Classification: [ ]
Mode of Payment: [ ]
Periodic Charge: [ ]
Processing Fee: $0
Renewal Conditions: By joining a plan, you are authorizing Metrodent to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Metrodent in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.
Termination Conditions: Metrodent and Careington reserve the right to terminate plan members from its plan for any reason, including non-payment. If Metrodent terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.
Cancellation Conditions: You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Metrodent will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Metrodent, 303 Merrick Road, Lynbrook, NY 11563 or fax to 877-414-4069. You may also submit cancellation requests by email: info@metrodentusa.com. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in FL, ND and OK, where you will receive a pro-rata refund whenever you cancel.
Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.
Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Careington. Careington is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by Careington. Careington is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Careington cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Careington are solely responsible for the professional advice and treatment rendered to members and Careington disclaims any liability with respect to such matters.
Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Careington International Corporation, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department.
Careington International Corporation (Careington)
7400 Gaylord Parkway Frisco, TX 75034
To add a family member to your plan, contact MetrodentUSA at 844-638-3368.
Group Code: V226
Group Name: MetrodentCare
Member ID:
Member Name & Address: [FIRST NAME M LASTNAME
123 ANY STREET APT1 ANY CITY, TX 12345]
Effective Date: [ ]
Term: [ ]
Total Fees:
Classification: [ ]
Mode of Payment: [ ]
Periodic Charge: [ ]
Processing Fee: $0
Renewal Conditions: By joining a plan, you are authorizing Metrodent to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Metrodent in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.
Termination Conditions: Metrodent and Careington reserve the right to terminate plan members from its plan for any reason, including non-payment. If Metrodent terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.
Cancellation Conditions: You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Metrodent will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Metrodent, 303 Merrick Road, Lynbrook, NY 11563 or fax to 877-414-4069. You may also submit cancellation requests by email: info@metrodentusa.com. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in FL, ND and OK, where you will receive a pro-rata refund whenever you cancel.
Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.
Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Careington. Careington is not a licensed insurer, health maintenance organization or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid by Careington. Careington is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Careington cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Careington are solely responsible for the professional advice and treatment rendered to members and Careington disclaims any liability with respect to such matters.
Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Careington International Corporation, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department.