Dental Crown & Bridges Restores Beautiful Smile & Confidence
Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile...
Transcript of Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile...
smileselect.com
Memberships start at just
$79see inside for details.
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Smile Select Membership is NOT INSURANCE, but
rather a licensed dental savings plan offered through
your local dental office. Members in good standing
with their annual membership fee are eligible to receive
transparent, member-only discounts from the normal
retail fees that participating offices typically charge self-
pay patients for dental services rendered. Plan details
and member savings are exclusive to participating
offices and may vary by location. The plan is not a
qualified health plan under the Affordable Health
Act. The plan does not meet the minimum creditable
coverage requirements under MGLC.111M and 956 CMR
5.00. Discount Medical Plan Organization “DMPO” and
plan administrator: Membersy LLC, 811 Barton Springs.
Suite 750, Austin, TX 78704.
Smile Select MembershipMembership Terms & Conditions
Whether you need a membership just for you, or your entire family, we’ve got you covered.
How It Works
Sign up online at: smileselect.com
Sign up over the phone:
(877) 545-4188
Send your completed application with payment:
Smile Select Membership 811 Barton Springs Rd. Ste. 750 Austin, TX 78704 We accept VISA, MasterCard, Discover, American Express, Personal Checks, and Money Orders.
Provide enrollment application with payment (checks must be payable to Smile Select Membership) to your participating dental office for submission to Smile Select.
INDIVIDUAL $$7979 PER YEAR
ADDITIONALMEMBERS
PER PERSON+$$2020
Now is the time to protect your healthy smile with the
affordable, easy-to-use Smile Select Membership.
All members instantly receive
20-50% OFF their dental services.
Smile Select Membership, an affordable choice for a lifetime of healthy smiles.
(888) 545-4188
Submit this form via mail, along with annual membership payment to plan administrator at:Membersy, 811 Barton Springs Rd. Suite 750, Austin, TX 78704
Membership FormProvider ID # Office Name Effective Date
First Name* Last Name* M.I
Address* Apt/#
City* State Zip*
Date of Birth Sex Male Female
Cell Phone* Home Phone* Preferred
Cell
Home
Email Address*
Eligible Dependents Name(s) | Additional $20 per additional member
On behalf of the above named individuals, I hereby apply for enrollment in Smile Select Membership and certify that the above information is true and correct.
Primary Member | Individual Membership cost is $79/yr.
Check or Money Order
Credit Card Visa MasterCard AmEx Discover/NOVUS
Credit Card #
Expiration Date / / CVV2 Number
Individual 1-Year Membership $79.00
Additional Membership(s) ( qty ) x + $20.00 (per person)
Authorization Signature Date
NO CASH ACCEPTEDmake payable to: Smile Select Membership
Need more information?Member Support can answer any questions, including enrollment, membership options, and more.Give us a call!
(877) 545-4188 What You GetIn addition to incredible discounts and perks, members receive:
It’s time to rethink your dental care.Smile Select members experience a different approach to traditional and outdated dental
insurance. With 50% OFF EXAMS & X-RAYS, PLUS 20-50% OFF all dental procedures, tons of perks and members-only exclusives - all starting on day one. What are you waiting for?
Start saving today!
Smile Select Membership is not insurance, therefore all applicants are guaranteed acceptance. Now, you can
have added confidence knowing this is a licensed dental membership program.
INSTANT ENROLLMENT
NO WAITINGPERIODS
PAY LESS,GET MORE
NO CLAIMSPROCESS
HASSLE FREE
Enroll online, in-office, or by phone in 2 minutes, and start saving right away.
No more annoying waiting - Become a member today for immediate savings.
Make your budget go even further
by never paying a deductible again.
All discounts are built-in, so say
goodbye to all that pesky paperwork.
Get all of your questions answered
by a dedicated support team.
MEMBERS-ONLY SAVINGS ON:
n Exams
n X-Rays
n Sealants
n Cleanings
n Fillings
n Extractions
n Root Canals
n Crowns
n Bridges
n Dentures
n Partials
n Implants
n Periodontics
n Cosmetic