This is NOT insurance and is not intended to replace health insurance. The plan does not pay providers directly. Discounted rates may vary depending on the type of provider and service. You may cancel within the first 30 days after payment and receive a refund of your annual fees, except the $15 non-refundable application fee. (Application fee is refundable for AR, LA, FL. MD receives a $10 refund). If you received services under the plan prior to cancellation, you may be responsible for paying your provider the difference between the discounted rated and your provider’s standard rates for the services performed (excluding LA residents). If your plan expires and you later decide to renew, another $15 non-refundable application fee may apply. Wellfit Plans, LLC is located at 3900 Teleport Blvd., PO Box 140309, Irving, TX 75014-0309 and can be reached at 833-333-7437

Exclusions
The following services are not covered under the plan and you are responsible for payment of the dentist’s usual and customary fees for these services: Services provided by a dentist who is not participating in the plan. Procedures deemed not reasonably necessary or not customarily performed, including, but not limited to services that have a poor prognosis and duplicate prosthetic devices or appliances, as determined by the dentist. Anesthesiologist services Treatment of Jaw fractures Or dislocations, congenital or developmental malformations, malignancies, cysts or neoplasms, or Temporomandibular Joint Syndrome (TMJ). Courses of treatment which began prior to the effective date of your plan and/or expenses incurred after termination of your plan. Any dental disease, defect or injury that arises out of any occupational incident or exposure for which you can receive benefits under applicable workers’ compensation law. Services of a specialist, including specialty x-rays such as CBCT’s. Cleaning types are determined by the diagnosis of the General Practitioner.Prophylaxis benefits are excluded in the presence of periodontal disease.

Limitations
You are responsible for payment of the dentist’s usual and customary rate (UR) for any of the following limited services: Replacement of partial dentures is limited to one per arch every two years. Replacement of full upper and lower dentures are limited to one per arch every two years. Replacement of fixed prosthetics such as crowns, bridges, inlays, and onlays is limited to once every year.

Continuity of Care
If a dentist leaves the dental office, the dental office is required to continue to provide any services that began prior to the dentist’s departure until your plan terminates at the discounted rates provided in your Membership Agreement. Your plan will auto-renew 12 months from the date of purchase and your application fee of $15 will be waived unless you change your renewal settings in the Member Portal at https://members.wellfit.com.

*Certain Limitations and Exclusion may apply.
**A 15% discount off additional services provided by the General Practitioner dentist. The dental office reserves the right to determine which procedures (ADA Codes) are included in the 15% discount. You may purchase additional quantities of the services included in the plan at a 15% discount.
***Includes a one-time, non-refundable $15 application fee.