Stumpf Dental Savings Plan
The Stumpf Dental Savings Plan is designed to provide affordability and greater access to quality dental care. If you recently lost your dental coverage, or never had dental benefits, this plan may be right for you.
With you Dental Savings Plan there are:
No Yearly Maximums
No Claim Forms
No Pre-authorization Requirements
No Pre-existing Condition Requirements
Immediate Eligibility (no waiting periods)
PREMIUMS (TOTAL COST):
Family (3) **
Family (4 or more)
$200.00 each additional member
Periodontal Savings Plan***
*The dual plan is for husband/wife or married couple.
**The family plan includes children who are enrolled full-time in
school until age 23, or children not enrolled full-time until age 18.
***Add to the benefit plans’ total annual cost an additional $240.00 per member.
Receive all the benefits of the Benefit Plan plus Perio Prophylaxis (100% coverage),
4 per year and Scaling and Root Planing (20% savings) and Fluoride (100% coverage),
4 per year.
Periodic exam (2 per year)
Limited oral exam, Problem focused (1 per year)
Intraoral x-ray; Complete full mouth series
Intraoral x-ray; Periapical, first film
Intraoral x-ray; Periapical, each additional film
Intraoral x-ray; Bitewings
Child Prophylaxis-Cleaning (2 per year)
Adult Prophylaxis-Cleaning (2 per year)
Fluoride (2 per year; no age limit)
Fillings (tooth colored composites)
Crowns and Bridges (including core build-ups)
Dentures and Partials
Renewal policy 5% off, Sign up for renewal before
old plan expires and receive 5% off next year’s premium.
Your plan’s effective date will be on file with the office.
You will not receive a membership card.
Your plan is valid for one year from date of sign up.
Any service not paid in full at time of service will be
billed at our normal rate.
This plan cannot be used in conjunction with any
other dental plan or insurance plan.
Appointments can be made one month in advance.
Broken appointments &/or cancellations with less than 48 hours’ notice are subject
to a $35.00 fee.
Exclusions and Limitations
This program is NOT a dental insurance plan. It was designed as a
savings plan for our loyal patients who do not have dental insurance benefits.
It cannot be used in conjunction with another dental plan.
It cannot be used for services for injuries covered by workman’s compensation.
It cannot be used for treatment which, in the sole opinion of the treating dentist
or doctor, lies outside the realm of their capabilities.
It cannot be used for referrals to specialists.
It cannot be used for hospitalization or hospital charges of any kind.
It cannot be used for costs of dental care which are covered under automobile
medical insurance or insurance of any kind.
It cannot be used in combination with any other offers or special discounts.
The Dental Savings Plan is honored only at Stumpf Dental, Ltd.
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