Dentist Friendly Member Eligibility

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Status	Full Name	Primary	Family Members	Start	Expiration	Membership ID Number
Status	Full Name	Primary	Family Members	Start	Expiration	Membership ID Number

THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.dentistfriendly.com. A written list of participating providers is available upon request. You may cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN residents will be refunded processing fee). Discount Plan Organization and administrator: Dentist Friendly, 2810 N Church St., PMB 94917, Wilmington, DE 19802; phone 1-877-222-4758. This plan is not for sale in CA,CT,DE,FL,IN,KS,LA,MD,MO, MT,NE,NV,NH,OK,OR,RI,SC,SD,UT, VT, WA, WV. Terms and conditions, features, support, pricing, and service options subject to change without notice.

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