+Certain State Restrictions:
No charge for members. Colorado & Maryland residents
are subject to a minimum of $1.00 fee per service and Washington
State residents are subject to a minimum of $13.00 fee per
service. Some restrictions apply.
The hearing instrument program is not available in Texas
or Colorado.
Ophthalmologists are not available in all areas.
Membership Benefits
Benefit Services of America, Inc. ("BSA")
and Dental Benefits Plus ("DBP")
are not direct providers of the benefits available to Members.
As a Member, You have access to discounts on various products
and services offered through the DBP
program, Customer Service Department and other benefits
and services offered by BSA and
independent vendors ("Membership") as specified
in Your Membership Agreement. The discounts provided by
DBP may not be used in conjunction
with any other discount plan or program. All listed or quoted
prices are current prices only and are subject to change
without notice. This is a discount medical plan only and it may be discontinued or modified at any time. BSA will
provide You notice of changes when applicable. The membership benefits may
only be used by You and any family members specifically
covered under the plan.
The health services provided in
this program may be duplicative of services and products
offered by your health insurance. DBP must be used as primary
coverage.
Payment of Membership Fee
All fees and charges associated with the DBP
Membership, including recurring and non-recurring charges
and fees applicable to Membership must be paid. The payment
of Your Membership fee is made automatically by a charge
to the specified payment method authorized by You. By authorizing
BSA to charge Your specified
payment method, You are authorizing BSA
and their respective designated representatives or agents
to automatically continue charging that account for all
fees and charges associated with Your Membership. If the
original
account information of the specified payment method changes,
You, or the credit-issuing entity, are responsible for informing
BSA of such new replacement information.
Your Membership is automatically renewed
monthly or annually in accordance with the payment option
selected. By signing up for the Membership, You are authorizing
automatic renewal of the program.
All accounts are processed during our payment
processing cycle once a month. Payments by check, money
order and/or cashiers check will only be accepted for our
annual plan and past due balances. We do not accept these
forms of payment for our monthly payment schedule.
We are unable to specify the exact date
on which the charges will process to Your account.
BSA is not responsible
or liable in any way for any charges or fees including,
but not limited to, Non-Sufficient Funds charges, which
a Member may incur from their financial institution due
to BSA's attempt to withdraw
payment for the Membership.
Billing Inquiries & Refunds
If You believe You have been billed in error for the Membership,
please notify our Customer Service Department about the
error.
Our refund policy requires proof of payment
received by our offices before any refund/credit will be
issued to the Member. Refunds will only be issued to the
primary Membership account holder, unless the account clearly
indicates the Membership was paid by another party or legal
proof is provided showing power of attorney over the primary
Membership holder's account. If a Member disputes charges
with their financial institution causing a "charge
back" which results in a duplicate refund to the Member;
BSA will charge the Member for
the amount of the original refund offered by BSA.
If the Member refuses to relinquish the funds back to BSA,
the company reserves the right to follow through on our
"Failure to Pay" procedures.
Cancellation You may
cancel Your Membership at any time simply by calling or
writing our Customer Service Department. A Member who elected
the pre-paid annual payment plan will be entitled to a refund
of the remaining paid months* on the Membership. A Member
who elected the monthly payment plan agrees that the monthly
charge for the month in which Membership is terminated will
be forfeited. As this Membership is not insurance, refunds
will not be issued for non-usage of the benefits.
*Note: "Remaining paid months" are
determined by the Membership effective date and the number
of months of service made available from the effective date
up to and including the month in which the Member terminated
services.
Failure to Pay If
BSA is unable to bill the Membership
fee to Your specified payment method at any time, BSA
reserves the right to terminate Your Membership without
notification. Should the funds not be available for whatever
reason during any given billing period, BSA
will continue to bill any past due and current due balances
until the Membership has been brought current. BSA
reserves the right to send an invoice directly to You and
may assign unpaid late balances to a collection agency for
appropriate action. If You fail to pay any charge when due,
or if You provide false or inaccurate information that is
required for the provision of the Membership or is necessary
for BSA to bill You for the Membership,
and such condition continues un-remedied for thirty (30)
days; You will be in default and BSA
reserves the right to suspend or terminate the Membership
at our sole discretion.
BSA reserves the
right to charge You a $10.00 fee for any check returned
to BSA relating to the membership.
BSA may modify its billing practices
or late payment charges by providing You with prior written
notice of the modification.
Complaint Procedure
Contact BSA for any problems
related to billing, service or a provider. BSA
will attempt to resolve billing issues and provider issues
by contacting the provider's office directly. If an issue
cannot be resolved directly, it will be forwarded to the
appropriate network representative with all the detailed
information.
Other non-billing issues, such as the state
of the facilities, discrepancies on provider's contract
or quality of services rendered will be referred directly
to the appropriate network contact. All issues will be documented
completely on the Member's account.
Use of Membership
Your Membership is non-assignable and non-transferable.
Only You and Your immediate family members may use the Membership.
The term "Immediate Family" shall be defined as
You, Your spouse, Your children and parents whose legal
address is the same as Yours. You shall be responsible for
all use of Your Membership and will promptly notify Us if
You become aware of any unauthorized use of Your Membership.
How to Add a Family Member
Call us toll free at 1-877-818-PLUS (7587) to speak with
a customer satisfaction specialist. Please have ready the
name and date of birth for the dependent you wish to add.
Please note that if you are on the individual plan you will
need to change to the family plan to add a family member
and the cost of your membership will change.
Product Availability
All services ordered are subject to availability of such
services and any information provided to the Member is subject
to change with notification.
Disclaimer of Liability
BSA and/or the sponsor do not
guarantee, nor are responsible for, the quality of products
or services provided by any independent vendors. BSA
and the sponsor are making no representations with respect
to those matters. Each Member acknowledges that he or she
is not relying on the skill or judgment of BSA
in selecting the benefits and services available to Members.
In the event any benefit is deemed unsatisfactory to the
Member, the Member will look solely to the provider or manufacturer
of the product, benefit or service for satisfaction and/or
rectification of a claim relative to the benefits, products
or services rendered.
Accordingly, BSA
and the sponsor make no warranty, expressed or implied,
including but not limited to the warranty
of merchantability or fitness for a particular purpose with
respect to any of the Membership services or products obtained
by a Member through Membership in BSA.
All warranties, expressed or implied, are the responsibility
of the manufacturer or independent vendor. Our liability
shall not exceed Your current Membership fee and under no
circumstance shall We be liable for incidental, consequential
or exemplary damages. BSA and
may revoke, repossess, modify or cancel the services at
any time. Use of the Membership is governed by the conditions
set forth herein when issued and retained, and any use or
non-use of this Membership constitutes acceptance thereof.
Entire Agreement This
agreement contains all of the terms and conditions of Membership
and no representations, inducements, promises or agreements
concerning the Membership not included in this agreement
shall be effective or enforceable. If any of the terms of
this agreement shall become invalid or unenforceable, the
remaining terms shall not be effected.
Reservation of Rights
We reserve the right to eliminate, add, change and substitute
benefits and participating vendors. We further reserve the
right to change the terms and conditions of this agreement
and any Membership policies at any time. Every effort will
be made to ensure that the number of providers is maintained.
Member will be notified promptly of any changes.
Governing Law This
agreement and the terms of the Membership shall be interpreted,
construed and enforced exclusively according to the laws
of the State of Florida. For any disputes regarding this
agreement, providing that if both parties mutually agree
at the time of the dispute to enter dispute resolution in
a local court residing in the county of residence of the
member to whose personal jurisdiction You agree to submit.
However, nothing in this agreement is intended or shall
be construed to negate or otherwise affect the consumer
protection laws of the state in which You reside.
Lost or Stolen Cards
Replacement Membership Cards may be obtained by calling
the Customer Service Department; once the request is placed,
a new card will be sent to You. There will be a $5.00 charge
for each card requested.
Additional Cards Additional
Membership Cards may be obtained by calling the Customer
Service Department; once the request is placed, the additional
card will be sent to You. There will be a $5.00 charge for
each additional card requested.
Membership Changes
Please contact our Customer Service Department if You need
to make any changes to the details of Your Membership.
We will inform You if Your DBP
coverage is impacted in any way including availability of
services and prices in a new area if You have changed locations.
Benefit Services of America, Inc.
101 Wymore Road, Suite 300
Altamonte Springs, Florida 32714-4313
1-877-818-PLUS (818-7587)
Monday to Friday - 9:00 a.m. to 8:00 p.m. (EST)
Fax toll free: 1-866-SMILE-28 (764-5328)
Email: custserv@dentalbenefitsplus.com
Please remember to include Your Membership
ID Number on ALL correspondence.
