Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile...

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smileselect.com Memberships start at just $ 79 see inside for details. SSLM-BRO powered by 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 Membership Membership 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 $ $ 79 79 PER YEAR ADDITIONAL MEMBERS PER PERSON + $ $ 20 20 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

Transcript of Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile...

Page 1: Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile Select members experience a different approach to traditional and outdated dental

smileselect.com

Memberships start at just

$79see inside for details.

SSLM-BRO

powered by

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

Page 2: Now is the time to protect your healthy smile with …It’s time to rethink your dental care. Smile Select members experience a different approach to traditional and outdated dental

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

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