Canyon Gate Membership Benefit Plan Agreement
The following terms and conditions of this Membership Agreement as well as the CanyonGateDental.com Terms of Use, Refund and Cancellation Policy which are incorporated herein by reference as if fully set forth below, govern the dental plan or dental program that you are purchasing through your submission of the enrollment form. All members subscribing to this plan should read this Agreement and the incorporated terms of use, Refund and Cancellation Policy and communicate any questions that may arise to Canyon Gate Dental representative at:
By Phone:(801) 764-9444
Fax:(801)
email:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
By mail: Canyon Gate Dental
440 West 800 North
Orem, UT 84057
Members Agreement
On behalf of yourself and your dependents, if applicable, the following are the terms and conditions of membership, including all documents included herein by reference above. By submitting your enrollment request form, you acknowledge that you have read (on your own behalf and on behalf of your enrolled dependents) the following terms and conditions:
1.Description of Programs Features
Each Member is entitled to receive discounts on specified services when using Canyon Gate Dental. Members are entitled to receive certain dental services from Canyon Gate Dental providers at predetermined rates and for a percentage discount off the normal retail prices for such dental services. If a Member is already insured, the Plan or Program benefits will supplement a percentage for expenses incurred after the insurance yearly maximum has been reached. Family plans consist of two (2) to four (4) individuals living dependently in a single household. If there are more than four Family Members in the household each additional Family Member can be added onto the Plan or Program at 25% of the annual family rate. Members must pay the Provider directly at the time of Service unless otherwise agreed upon between Canyon Gate Dental and the Member.
2.Membership Term
Once the initial fee for membership in the Plan or Program (Membership Fee) and any enrollment or processing fee is paid and received, a Member will be entitled to all discounte4d dental services for the time period (Membership Term) that the member selects at the time of purchase. The Member will receive a Plan or Program activation notice with such activation commencing within 72 hours of the purchase and remaining in force as long as Member continues to pay required Membership fees and otherwise complies with the terms of this Agreement. Members may select from Membership Terms offered at the time of activation which include annual options. Member may change the Membership Term by calling Canyon Gate Dental before the new Membership Term.
3.Automatic Renewal of Membership Term
YOUR MEMBERSHIP WILL BE AUTOMATICALLY RENEWED THREE (3) WEEKS PRIOR TO THE EXPIRATION DATE IDENTIFIED IN YOUR ORDER CONFIRMATION. At the conclusion of your Membership Term, Membership in the Plan or Program will be renewed automatically unless the Member notifies Canyon Gate Dental, either by telephoning a Member Services Representative or by providing written notification to Canyon Gate Dental before the new Membership Term, that he/she wishes to cancel his/her membership in the Program. Unless you are otherwise advised in advance by Canyon Gate Dental, in the event that your initial membership order is paid in the form of an electronic payment 9credit card or electronic check for the withdrawal of funds from your checking account), the automatic renewal will also be charged to the same credit card or checking account that you provide in making your initial membership order. If the member fails either to notify Canyon Gate Dental in writing that the member is terminating the Membership, Membership in the program will be renewed automatically and the Membership Fee for an additional term will b e charged against the Members Credit Card or debit to the Members checking account, if applicable. If the Member paid for the previous Membership by check, then he/she will be sent a bill for the Membership Fee. Should a Member have any questions concerning the program, or the continuation or cancellation of Membership, he/she should telephone a representative at Canyon Gate Dental.
4. Cancellation and Refund Policy
If a Member wishes to cancel and /or terminate his/her Membership, the Member may cancel their Membership in accordance with the Canyon Gate Dental Refund Policy then in effect. If a member cancels his or her policy within the first 30 days after the effective date of enrollment in the plan, the member will receive a full refund upon receipt by Canyon Gate Dental of the members written notification of cancellation. A full refund will be made within 30 days of receipt of the notice of cancellation. All full refund cancellation notices must be sent in writing and received within 30 yard of initial purchase via mail to:
Canyon Gate Dental
440 West 800 North
Orem, UT 84057
After 30 days of initial purchase, the Canyon Gate Dental Refund Policy is as follows: A Member is eligible to receive prorated refund only if: (All pro-rata cancellation notices must be sent in writing and received at the above address.) Canyon Gate Dental cancels a membership for any reason other than nonpayment of fees by member, or the discounted savings are not realized on care delivered, or The fee schedule of the plan you have selected is not honored by Canyon Gate Dental. Applies to Automatic Renewals Only: In the event that your plan has been automatically renewed in any year following your initial purchase and provided that your discount plan benefits have not been used, a full refund will be issued within the first 60 days of the automatic renewal. After 60 days of automatic renewal, the Canyon Gate Dental Refund Policy is as follows: (All cancellation notices must be sent in writing and received at the above address.) A member is eligible to receive a prorated refund only if: Canyon Gate Dental cancels a membership for any other reason other than nonpayment by a member, or Discounted savings are not realized on care delivered, or The fee schedule of the plan you have selected is not honored by Canyon Gate Dental. All refunds will be issued within 30 days of receipt of the notice of cancellation.
5. Complaint Procedure
Any complaint regarding Plan or Program Membership should be directed to Canyon Gate Dental by telephone, www.NinthEastDental.com, or in writing to the address shown above.
6. Membership Payment/Billing
Unless payment is made by check or cash, payment of the initial membership Fee and /or any renewal membership Fee will be made automatically by a charge against the Members credit card or by a debit to the Members Checking account (depending on the payment option authorized by the the Member) for the full amount of the Membership Fee for the membership term. The member will be notified of the billing on his/her credit card or checking account statement. Each member hereby authorizes Canyon Gate Dental to bill and receive payments for the Membership Fee as set forth in the Agreement. Canyon Gate Dental reserves the right to increase the Membership Fee for a future Membership Term, in which case them member will be notified of the increased Membership Fee, which will be effective upon renewal of the Program membership. Checks returned as unpaid, (NSF) will be assessed a $35.00 service charge. Past Due accounts that are not brought current within 15 days of the e-mail notice are subject to suspension and possible account termination. Unless you are otherwise advised in advance by Canyon Gate Dental, in the event that your initial membership order is paid in the form of an electronic payment )credit card or electronic check for the withdrawal of funds from your checking account), the automatic renewal will also be charged to the same credit card of checking account that you provide in making your initial membership order. Provided that your discount plan benefits have not been used, a full refund will be issued within the first 60 days of the automatic renewal. After the 60 days, membership is subject to the cancellation policy detailed above. In order for your membership to continue without interruption, your payment must be received three (3) weeks prior to the expiration date identified in you order confirmation. In the event you Canyon Gate Dental attempts to automatically renew your membership but is unable to do so due to the cancellation or inactivation of your credit card or other form of electronic payment, Canyon Gate Dental will attempt to notify the member through email address on record. In all events, it is the responsibility of the member to ensure that Canyon Gate Dental has received payment for membership renewal three (3) weeks prior to the expiration date identified in the order confirmation. Canyon Gate Dental is not responsible and assumes no liability to any member or members failure to provide Canyon Gate Dental with current payment information for membership renewal.
7. Member Acknowledgements
Membership in the Plan or Program and or Members rights or duties under this agreement may not be assigned or delegated without prior express written consent of Canyon Gate Dental. Member agrees that he/she will use his/her plan or Program Membership only for his/her personal benefit or for the benefit of his/her Family Members (if Family Plan Program is elected.) Family Members are defined by the specific plan of Program chosen by the member. A Members violation of this Paragraph may, at the discretion of Canyon Gate Dental, result in payment of or contribution to any use, sales or other tax that may be imposed on the dental services by federal, state or other taxing authority. Payment of such taxes will remain the sole responsibility of the Member or the Provider of the dental services, as applicable. Member is responsible for paying Provider for all dental services rendered unless otherwise agreed upon by Member and Provider. The program is not an insurance and it may not reduce deductibles, co-payments or other out-of-pocket expenses for dental services that are covered by insurance. The Dentist has agreed to make certain services and supplies available to Members on a Reduced fee Service Basis. The term Reduced Fee Service means a service that is available to a Member at a discount from fees normally charged by the provider and for which the Member is solely financially responsible. Member understands that all payments to providers are due and payable at the time of service, unless anther payment arrangement is mutually agreed upon between the Member and treating Provider.
8. Notices
Any notice, consent, approval, complaint, request or other written communication given or required under this Agreement must be sent by first class mail, postage prepaid, or by an overnight delivery service such as FedEx or UPS, and addressed to the Member at the address shown for Canyon Gate Dental records, or from the Member to Canyon Gate Dental, at:
Canyon Gate Dental
440 West 800 North
Orem, UT 84057
9.Entire Agreement
This Agreement, taken in conjunction with the Canyon Gate Dental Terms of use and Refund and Cancellation Policy, are hereby incorporated by reference, set forth the entire agreement and understanding between parties with regard to members Membership in the Plan or Program and constitutes a final, complete and exclusive statement of the terms of the agreement between the parties with respect to Members Membership in the Plan or Program. Any other representation, inducement, promise, or agreement shall be of no force or effect.
12. Validity and Enforceability:
The validity or unenforceability of any term of this Agreement will no no way affect the validity of enforceability of any other term of this Agreement.
13. Governing Law
This Agreement will be governed and construed in accordance with the laws of the State of Utah regardless of any application or principles regarding conflicts of laws.
14. Headings
The headings or captions provided throughout this Agreement are for reference purposes only and will in no way affect the meaning or interpretation of this Agreement.
15. Amendment
Except as otherwise set forth in the Terms of Use, this Agreement may only be amended in a writing signed or otherwise electronically acknowledged by the parties.
16. Waiver or Breach
A waiver by Canyon Gate Dental of a breach of any provision of this Agreement will not be deemed a waiver by Canyon Gate Dental of any other breach of the same or different provision.
DISCLOSURE:
Plans and Programs offered by Canyon Gate Dental are not health insurance policies. Plans and Programs offered by Canyon Gate Dental provide discounts at Canyon Gate Dental for dental services. The Plan or Program Member is obligated to pay for all dental care services but will receive a discount from Canyon Gate Dental.
____________________________________
Member Signature and Date
____________________________________
Member Name
Canyon Gate Dental
440 West 800 North
Orem, UT 84057
Address:____________________________________________________________________________________________________
Representative Signature and Date
______________________________ _________________________________________
Representative Name
Email_______________________________