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General Terms and Conditions.

The Practice and its Provider(s) will directly offer its patients a membership plan where eligible patients can receive certain dental services in exchange for a membership fee. By signing this Agreement, you agree to enroll in the membership plan, and be subject to the membership terms below. 

These plans are NOT INSURANCE. This plan does not provide insurance coverage, pay claims, or reimburse for services, and should not be used as a substitute for dental insurance or any other health coverage.

Members in good standing with their annual/monthly membership fee are eligible to receive discounts from the normal retail fees that participating offices typically charge self-pay patients for treatment. Plan details, including Covered Services, pricing and discounts are exclusive to participating practices and may vary by location. Plan Forward does not make payments directly to care providers for any services offered to members. Members are obligated to pay for all services, but will receive a discount on certain services rendered by participating providers. At the discretion of the Practice, the savings offered in the membership plan may not be combined with any other offers or discounts. A complete list of participating providers in your local area and the services for which discounts are applicable is available upon request by calling Plan Forward Member Support at (833) 752-7526, or visiting www.planforward.io. 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. 

Plan Forward, Inc., 750 Veterans Wy Ste 120, Carmel, IN 46032.  

  1. What This Agreement Covers

Covered Services include the routine and preventive dental care listed in Schedule A. It does not include non-dental care or anything else not specifically listed as a Covered Service. Anything that isn’t a Covered Service will be billed separately, at the Practice’s standard fee schedule or at a discount, and you’re solely responsible for paying those charges.  

This Agreement applies only at Practice locations that have agreed to offer this membership plan.  

  1. Joining the Program; Covered Services

(a)  The Agreement takes effect on signing, and thereafter you are entitled to the Covered Services, without any waiting period.  

(b) Subject to compliance with applicable law, the Practice reserves the right to add, modify, or discontinue one or more Covered Services, participating Providers, office locations,  and/or other aspects of the membership in its sole discretion, and will provide Member, as necessary, with written notice at least thirty (30) days prior to the change.

(c) The Practice will use reasonable efforts to give you timely access to Covered Services. However, nothing in this Agreement guarantees: immediate access to a Provider; availability of a specific Provider; availability at specific dates or times. The Practice decides, using its clinical and operational judgment, the most appropriate way to provide Covered Services.

(d) With membership, you have access to the Covered Services from participating Providers, who are independent healthcare professionals and who use their own professional judgment. Providers may offer the general public services, products, discounts, promotions, or pricing that differ from, and may be better than, what’s available through the membership. Neither the Practice nor the Platform Provider (defined in Section 8) promises that the membership program is the lowest price available. Any Provider’s participation in the membership Program may change at any time.

  1. Fees

The Fees for membership are included in Schedule B. The Practice may change Fees at any time, and you will be given at least 30 days notice before any Fee changes take effect. You must keep a current, valid, authorized payment method on file with the Practice for the entire Term of this Agreement (defined in Section 5).

BY SIGNING THIS AGREEMENT, YOU EXPRESSLY AUTHORIZE THE PRACTICE, THE PLATFORM PROVIDER, AND THEIR DESIGNATED THIRD-PARTY PAYMENT PROCESSOR(S) TO CHARGE, INCLUDING RECURRING CHARGES TO, ANY CREDIT CARD, DEBIT CARD, BANK ACCOUNT (INCLUDING ACH DEBITS), OR OTHER PAYMENT METHOD YOU PROVIDE, FOR ALL FEES AND OTHER AMOUNTS DUE UNDER THIS AGREEMENT, INCLUDING MEMBERSHIP FEES, ENROLLMENT FEES, RENEWAL FEES, TERMINATION FEES, APPLICABLE TAXES, PAST-DUE AMOUNTS, RETURNED-PAYMENT FEES, CHARGEBACK FEES, COLLECTION COSTS (TO THE EXTENT THE LAW ALLOWS), AND ANY OTHER AUTHORIZED CHARGES UNDER THIS AGREEMENT.

This authorization stays in full effect for the entire Term, unless and until this Agreement is terminated according to its terms and everything you owe has been paid in full. You also authorize the Practice and its payment processor to retry any payment that’s unsuccessful. You are responsible for promptly updating your payment information, and you remain liable for everything you owe under this Agreement regardless of whether an automatic payment is declined, reversed, or otherwise unsuccessful.

If any Fee or other amount due under this Agreement is unpaid when due, the Practice may suspend your access to Covered Services until everything owed is paid in full or end this Agreement as allowed under its terms. You remain responsible for all fees owed for this plan during the current term even if your membership is suspended or ended.

  1. Refunds

Except as required by state law, all Fees and other amounts paid or owed under this Agreement are non-refundable. Any Covered Services you don’t use during your Initial Term or a Renewal Term (defined in Section 5) expire at the end of that term; they don’t carry over, nor can they be transferred to anyone else, or exchanged for cash, credit, or anything else. Any refund the Practice does issue is at its discretion, unless the law requires otherwise.

Refer to your signed Membership Agreement for state specific Refund rights.

  1. Term; Renewal; Termination

(a) This Agreement begins on your Enrollment Date and lasts for an initial term of one year (the “Initial Term”), unless it ends earlier under this Agreement.

(b) Automatic Renewal. When the Initial Term ends, as long as all applicable Fees are paid, this Agreement automatically renews for additional one-year terms (“Renewal Term”) unless  either Party gives the other at least 30 days’ written notice of non-renewal.  

(c)  You may end this Agreement at any time by giving the Practice at least 30 days’ written notice. Your termination takes effect: (i) at the end of the next full billing cycle after the Practice receives your notice, if you’re on the monthly Membership Fee plan; or (ii) at the end of that 30-day notice period, if you’re on the annual Membership Fee plan. You remain responsible for all Fees and other amounts owed through the end of your current term, even if you are on a monthly plan.

(d) The Practice may end this Agreement at any time by giving you at least 30 days’ written notice, consistent with the law and its professional obligations regarding continuity of care. The Practice may also suspend your access to Covered Services, or end this Agreement immediately with written notice, if: (i) any Fee or other amount you owe stays unpaid 15 days after its due date; (ii) you engage in fraud, abuse, threatening, harassing, disruptive, inappropriate, or unsafe behavior, or otherwise misuse the membership, as the Practice reasonably determines; (iii) you break this Agreement or violate the law; (iv) the Practice determines that continuing the provider-patient relationship is no longer clinically appropriate or operationally workable; or (v) the law otherwise allows or requires termination. You remain responsible for all Fees and other amounts owed through the date this Agreement ends.

(e) Once this Agreement ends, you’re no longer eligible to receive Covered Services under the membership. Ending this Agreement doesn’t relieve you of any obligation to pay amounts you owed, or that accrued, before it ended.

  1. This Program Does Not Involve Insurance Billing

You acknowledge that Covered Services under this Agreement cannot be billed to any health insurance issuer, health maintenance organization (“HMO”), other health plan, or federal or state healthcare program, including Medicare or Medicaid (together, “Plans”). You remain solely responsible for all charges for anything that isn’t a Covered Service. Please promptly tell the Practice if you’re enrolled in Medicare, Medicaid, or any other Plan, or if you become enrolled in one while you’re a member.

  1. Tax-Advantaged Medical Savings Accounts

The Practice cannot confirm the tax treatment of Fees paid under this Agreement, or about whether those Fees qualify as eligible expenses under any Tax-Advantaged Savings Account such as HSA, FSA, etc. You’re solely responsible for determining that eligibility, getting any necessary approvals, and following all applicable tax laws and requirements.  

  1. Membership Platform; Third-Party Services

The Practice uses a technology platform (the “Platform”) from Plan Forward, Inc., together with its affiliates, licensors, service providers, contractors, subcontractors, vendors, agents, and representatives (together, the “Platform Provider”), to manage the membership. You acknowledge and agree that the Platform Provider are independent contractors engaged by the Practice. They do not provide healthcare services, including Covered Services; do not exercise clinical judgment; do not have a provider-patient relationship with you; and do not take on any responsibility or liability for the medical care, treatment, advice, diagnosis, or professional services the Practice or its Providers give you. All healthcare services are provided solely by the Practice and its Providers. To the extent the law allows, the Platform Provider is not liable for any healthcare services, treatment decisions, diagnoses, misdiagnoses, delays in treatment, treatment outcomes, prescriptions, referrals, professional services, products, acts, omissions, negligence, malpractice, or other conduct of any Provider, the Practice, any healthcare professional, or any healthcare facility.

  1. Authorization to Share Protected Health Information

Protected health information under HIPAA will be used and disclosed by the Practice as the law permits or requires. You acknowledge and agree that the Practice may collect, use, disclose, transmit, and otherwise share your information, including personal information, billing information, payment information, and, to the extent the law allows, PHI with the Platform Provider and other authorized third-party service providers the Practice engages.  

  1. Electronic Communications

Unless you tell the Practice otherwise in writing, you authorize the Practice and its Providers, staff, and designees to communicate with you about your PHI electronically, including by phone call, email, text (SMS/MMS), patient portal messaging, audio or video conference, or chat (“Electronic Communications”). You acknowledge and agree that:

  •     Electronic Communications may not be a secure way to send or receive PHI;
  •     The Practice and its providers and staff will make commercially reasonable efforts to keep unencrypted Electronic Communications with you confidential and secure, but the Practice cannot guarantee the confidentiality of unencrypted or unsecure Electronic Communications;
  •     Electronic Communications may become part of your medical record;
  •     You will not use Electronic Communications for emergency or urgent medical problems, other time-sensitive issues, or sensitive inquiries. If you have an emergency, or a situation that could reasonably turn into one, call 911 or go to the nearest emergency room, and follow the instructions of emergency personnel; and
  •     Neither the Practice nor its Providers, staff, agents, or representatives will be liable to you for any loss, cost, injury, or expense caused by or resulting from: (i) a delay in responding to you due to technical failures, including internet service outages, power outages, failure of electronic messaging software, failure of computers or computer networks, or faulty telephone or cable data transmission; (ii) any interception of Electronic Communications by a third party; or (iii) your failure to follow the guidelines in this Section.
  1. No Guarantee the Platform Will Always Be Available

TO THE FULLEST EXTENT THE LAW ALLOWS, THE PLATFORM PROVIDER HAS NO LIABILITY OR RESPONSIBILITY TO YOU FOR ANY UNAVAILABILITY OF, DELAY IN ACCESS TO, INTERRUPTION OF, DEGRADED PERFORMANCE OF, OR FAILURE OF THE DPC PROGRAM, THE PLATFORM, OR ANY RELATED TECHNOLOGY, SYSTEMS, APPLICATIONS, OR SERVICES, INCLUDING ANY RESULTING LOSS OF DATA, LOSS OF COMMUNICATIONS, DELAYED TRANSACTIONS, PAYMENT PROCESSING ISSUES, OR INABILITY TO ACCESS MEMBERSHIP INFORMATION OR PROGRAM FEATURES. YOU AGREE NOT TO BRING ANY CLAIM RELATING TO THE AVAILABILITY, ACCESSIBILITY, CONTINUITY, OPERATION, OR PERFORMANCE OF THE DPC PROGRAM, THE PLATFORM, OR ANY RELATED TECHNOLOGY SERVICES AGAINST THE PLATFORM PROVIDER.

  1. Protecting the Practice and Platform Provider From Claims; Limits on Liability

(a) Hold Harmless. To the fullest extent the law allows, you agree to hold harmless the Practice, the Platform Provider, their affiliates, and their respective owners, officers, directors, managers, employees, Providers, contractors, agents, successors, assigns, payment processors, technology providers, and service providers (together, “Practice Indemnitees”) from and against any claims, losses, liabilities, damages, costs, or expenses arising from or relating to: (a) your breach of this Agreement or any applicable Platform Terms; (b) your misuse, improper use, or unauthorized use of the membership, the Platform, or the Covered Services; (c) any false, inaccurate, incomplete, or misleading information you provided; (d) your violation of applicable law; or (e) the acts or omissions of you or anyone acting on your behalf. No Practice Indemnitee is responsible for any loss, damage, claim, or liability resulting from your failure to meet your obligations under this Agreement. This Section continues to apply after this Agreement is terminated or expires.

(b) LIMITATION OF LIABILITY. TO THE FULLEST EXTENT THE LAW ALLOWS: (I) NEITHER THE PRACTICE NOR OTHER PRACTICE INDEMNITEES ARE LIABLE FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES ARISING FROM OR RELATING TO THIS AGREEMENT OR THE MEMBERSHIP; AND (II) THE TOTAL LIABILITY OF THE PRACTICE AND OTHER PRACTICE INDEMNITEES ARISING FROM THIS AGREEMENT WILL NOT EXCEED THE FEES YOU PAID UNDER THIS AGREEMENT DURING THE 12 MONTHS BEFORE THE EVENT THAT GAVE RISE TO THE CLAIM.

  1. Other Important Terms

(a) Entire Agreement. This Agreement, including all attached Schedules, is the entire understanding between you and the Practice about the subjects covered here. It can only be changed or amended in writing, signed by both Parties.

(b) Waiver. For either Party’s waiver of a breach of this Agreement to count, it must be in writing and signed by the waiving Party. A waiver of one breach does not waive any later breach by either Party.

(c) This Agreement and the rights and obligations of the Practice and Member hereunder shall be construed and governed under the laws of the State in which the Practice is located, without regard to its conflict of laws principles. All disputes arising out of this Agreement shall be brought in a court of proper venue and jurisdiction in the State in which the Practice is located and the Parties irrevocable submit to the exclusive jurisdiction of such courts.

EACH PARTY ACKNOWLEDGES AND AGREES THAT ANY CONTROVERSY WHICH MAY ARISE UNDER THIS AGREEMENT IS LIKELY TO INVOLVE COMPLICATED AND DIFFICULT ISSUES, AND THEREFORE, EACH PARTY HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVES ANY RIGHT TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AGREEMENT AND ANY OF THE AGREEMENTS DELIVERED WITH THIS AGREEMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY OR THEREBY.

(d) Assignment. This Agreement binds, and benefits, the Parties and their respective successors and permitted assigns. Neither this Agreement nor any rights under it may be assigned by you without the Practice’s written consent. Covered Services are personal to you and may not be transferred, shared, assigned, sold, gifted, or used by anyone else.

(e) Severability. If a court of competent jurisdiction finds any part of this Agreement legally invalid or unenforceable in a jurisdiction where it applies, the rest of the Agreement remains valid, and that part will be considered modified to the minimum extent needed to make it consistent with the law and, in that modified form, will remain enforceable.

(f) Third-Party Beneficiaries. Except as stated in this Section 13(f), this Agreement is entered into solely for the benefit of the Parties and their respective permitted successors and assigns. Nothing in this Agreement gives any person or entity other than the Parties any legal or equitable right, benefit, remedy, or claim. However, the Parties agree that the Practice Indemnitees (other than the Practice) are intended third-party beneficiaries of the parts of this Agreement meant to protect them, including Sections 2, 11, and 12.

(g) Force Majeure. Neither the Practice nor any Practice Indemnitee is liable for delays or an inability to provide Covered Services or otherwise perform this Agreement resulting from events beyond its reasonable control, including natural disasters, pandemics, government actions, labor disputes, technology failures, utility interruptions, cyber incidents, or acts of third parties.

(h) Survival. Any part of this Agreement that by its nature is meant to continue after this Agreement is terminated or expires will survive, including Sections 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13, along with any other rights or obligations that came up before the effective date of termination.

(i) Counterparts. The Parties may sign this Agreement in separate copies, each considered an original, which together are considered one document, including by electronic signatures sent as a PDF or similar format.