Program Exclusions and Limitations

This program is a discount plan, not a dental insurance plan and is secondary to any other dental plan. It cannot be used:

• In conjunction with another dental plan
• For services for injuries covered under workman's compensation
• For treatment which, in the sole opinion of the treating dentist or doctor, lies outside the realm of their capability
• For referrals to specialists
• For hospitalization or hospital charges of any kind
• For costs of dental care which are covered under automobile medical claims
• For treatment which, in the sole opinion of the treating dentist or doctor, lies outside the realm of their capability
• For referrals to specialists
• For hospitalization or hospital charges of any kind
• For costs of dental care which are covered under automobile medical claims

This plan is only honored at Mortenson Family Dental, BracesBracesBraces, Oral & Facial Surgery Group and Kid’s Dentistry locations. This dental plan is not an insurance plan that can be used at any other dental office.

Program Guidelines:

• You will not receive a membership card — your plan’s effective date will be on file with the receptionist
• Benefit coverage table is subject to revision annually
• There will be a $50 reinstatement fee if your plan lapses
• Cannot be used in conjunction with another dental plan
• NON-REFUNDABLE
• No refunds or premiums will be issued at any time if participant decides not to utilize dental plan

*The Dual Plan is for Parent/Child or Husband/Wife only.

**The Family Plan includes children who are enrolled full-time in college until age 23, or children who are not enrolled full-time in college until age 18.