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Brident, Inc. Discount Dental Program

Terms and Conditions

Terms and Conditions for the state of Texas

This program is NOT insurance or a health insurance policy. This program is a discount membership program offered by Brident, Inc. This discount dental program is not a Qualified Health Plan under the Affordable Care Act and does not meet minimum essential coverage requirements. Brident, Inc. 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 Brident, Inc. Brident, Inc. is not licensed to provide and does not provide medical or dental services or items to individuals. Brident, Inc. does not guarantee the quality of the services or products offered by the providers. You will receive discounts for dental services at Brident Dental & Orthodontics. Discounts provided by this program cannot be combined with any other insurance products. You are obligated to pay for all dental services at the time services are rendered.

Term: By joining this plan, you are enrolling in this discount membership program for a term of twelve (12) months. By joining, you indicate you have read the terms and conditions of the plan.

Annual Fee: The annual fee for membership in the discount dental program is $99.00 for the member only, $119.00 for member and one dependent, and $139.00 for the member and immediate family. If the annual fee for the discount membership program is not paid in full when due, then you shall be deemed not to have enrolled in the plan.

Termination: Brident, Inc. reserves the right to terminate plan members from this discount plan for any reason, at its sole discretion, including non-payment.

Cancellation: Within the fi rst 30 days after you enroll with the discount program, you have the right to cancel for any reason and receive a full refund of the membership fee. If you choose to cancel during this period, you will be charged a one-time processing fee of $25.00. To cancel and obtain a refund of the membership fee as set forth herein, you must submit a written cancellation letter and a request for refund with your name and member number to Customer Service, Brident, Inc., P.O. Box 14226, Orange, CA 92863. Alternatively, for cancellations, you may call Brident, Inc.’s Customer Service Department at 1-866-336-4206.

Limitations, Exclusions, & Exceptions: 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 your individual provider. This is a stand-alone product; the discounts contained herein 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. Certain procedures offered by providers are not discounted under this program. Discounts on professional services are not available where prohibited by law. Please call our Customer Service Department
at 1-866-336-4206 for a current list of Brident Dental & Orthodontics providers. At any time, Brident, Inc. has the right to eliminate a participating provider and may substitute provider networks at its sole discretion. Brident, Inc. cannot guarantee the continued participation of any provider. Providers contracted by Brident, Inc. are solely responsible
for the professional and clinical advice and treatment rendered to members and Brident, Inc. disclaims any liability with respect to such matters. Services and service providers may change or be discontinued at any time with notice as required by law.

Complaint Procedures: If you have any questions or problems, please call Brident, Inc.’s Customer Service Department at 1-866-336-4206. If you would like to fi le a complaint or grievance regarding your plan membership, you must submit your grievance in writing to: Brident, Inc., P.O. Box 14226, Orange, CA 92863. All complaints or grievances are documented in the monthly Quality Assurance log along with the date and content of the complaint or grievance. All grievances will be acknowledged in writing within five (5) business days after receipt. Complaints will be researched and resolved within thirty (30) days from the date of receipt. Members have the right to request an appeal of the complaint and grievance resolution. Appeals will be entitled to a second review with different individuals. If the member is still dissatisfi ed after completing the appeal process, the member may contact the Texas Department of Insurance for further review. For questions or assistance with fi ling a complaint, please call 1-800-252-3439 or visit www.tdi.texas.gov/consumer/complfrm.html.