If you are an existing patient enrolling in the SmileGuard Plan, your account must have a zero balance.

This plan may be used only at Brookstone Dental and applies only to dental procedures offered at Brookstone Dental.  The Membership Plan includes services normally covered in the scope of General Dentistry.

There may be instances where dental care needs fall beyond the scope of services provided at Brookstone Dental.  Patients with specialty dental care needs will be advised as soon as possible and referred to the appropriate dental specialists.  Referred services are NOT covered by this membership plan and will not be subject to the discounts of the plan.  After specialty services have been performed, the patient may return Brookstone Dental to receive treatment discounts covered under the Membership Plan.

This plan is not retro-active and will become effective on the date of enrollment.

It is the member's responsibility to utilize the services included in this agreement within their plan year limit.  Any unused benefits will not be carried over or refunded.

This plan is non-transferable and annual plan is non-refundable.  Family members not enrolled under their own plan cannot be substitutes for another plan-enrolled family member.

Per Michigan Direct Primary Care Agreement (DPCA) guidelines, each additional family member must be enrolled at the time of the initial membership or at renewal time.

In exchange for the care provided under this plan, the covered member agrees to pay all balances in full at the time of treatment for any work that is not 100% covered by the plan.  If treatment is not paid in full at the time of service, the treatment discount is void.

Should there be dental treatment needed following any type of injury where a lawsuit, and therefore outside medical, care, disability, or workers comp type insurances are involved, this discount plan cannot be used.

Plan discounts are towards dental treatment only.  Unless otherwise stated in the plan, products are not subject to the discount.

Membership must be current to be eligible for the discounts.

The member has the right to opt out of the plan for a full refund within 30 days of enrollment if no treatment has not started.  If ANY treatment has been performed or if 30 days from enrollment have lapsed, no refund will be provided. 

If a member chooses to terminate the plan at any time past the initial 30-day grace period, there will be a cancellation penalty of $250 assessed.

The member gives consent to Brookstone Dental to process their credit card for either the monthly or annual plan.

Services are based on a plan year.  The membership begins on the date of enrollment and eligibility will remain active for one year.  Your annual membership will be automatically renewed at the end of each plan year unless you choose to discontinue your coverage at that time.

For the Monthly Plan option, there will be a one-time enrollment fee of $49 and a 5% monthly surcharge.

As part of this membership, no deductibles, pre-authorizations, annual maximums, or waiting period (other than normal scheduling times) will be required for treatments.

It is the patient’s responsibility to schedule and keep all appointments offered as part of the SmileGuard membership program.  A fee (based on length of appointment) may be incurred for each broken appointment without at least 24 hours advance notice.  Missed appointment fees are ineligible for the membership discount.

Plan fees/rates are subject to change at the conclusion of each contract year.  Member will be informed of any potential increase in annual membership fees prior to renewal.

Members are required to notify Brookstone Dental of any address, contact, and credit card changes.

This is NOT an insurance plan and not subject to regulation by the state department of insurance, including the minimal essential coverage required by applicable federal law.  It provides only the services described herein.

Brookstone Dental may terminate the membership plan at any time by written notice to the patient if terminating the doctor/patient relationship or if discontinuing the plan.  In in this case, the patient will receive a pro-rated discount if paid annually and the early cancellation penalty will be waived.

Brookstone Dental retains the right to interpret the program stipulations.