Terms and Conditions Program Description. Sage Dental Group of Florida, PLLC, and Sage Dental Group of Georgia, LLC’s, collectively “Sage Dental”, SageCare+ Loyalty Program (the “Program”) is an internal program offered to Sage Dental patients. Program benefits are available exclusively at Sage Dental practices. For Sage Dental practice locations visit: www.mysagedental.com/find-locations. THIS PROGRAM IS NOT INSURANCE or a registered or regulated insurance or discount plan. The Program’s fees are not insurance benefits. The Program is not intended to replace health insurance and cannot be used in addition to a dental insurance plan. Membership Term; Automatic Renewal. Upon receipt of the Membership Fee, (the “Activation Date”) Program members will be entitled to reduced fees for certain dental services at Sage Dental practices. Program Membership is for one year from the Activation Date and auto renews for additional one-year periods upon the anniversary of the Activation Date (initial year and any auto renewal referred to as the “Membership Term”). Program members’ information will be saved to file for future transactions on their account (such as auto-renewal), which may be processed from any Sage Dental location. Membership Fees. The Membership Fee is non-refundable after the plan has been used toward treatment received, or 30 days after the Activation or Renewal Date, even if the member did not utilize the plan for treatment. Sage Dental reserves the right to change the Membership Fee for future Membership Terms. Additional Members. At any time during the Membership Term, a primary member may add members [up to 6 total on a Program Membership] for an additional Membership Fee per additional member. The primary member’s Membership Term date applies to all additional members on the Program Membership. Program Benefits. Program includes only those procedures listed on Sage Dental’s website: www.mysagedental.com. Members acknowledge that they may incur out-of-pocket fees and expenses and that their dental provider(s) may not perform all related dental services and may not treat certain age groups. To the extent permitted by law, members authorize Sage Dental and the treating providers to use or disclose a member’s dental records and health information to other Sage Dental offices and providers. Program Exclusions. Program Fees cannot be applied to insurance copayments or deductibles or be combined with medical and dental insurance benefits, other special offers, or sales promotions advertised by Sage Dental, any third-party discounts, coupons, offers, or other dental discount plan benefits. Program Fees do not apply to treatment started before the Activation Date or after patient’s Membership Term expires or ends for any reason. Only patients with healthy gum tissue as diagnosed by Sage Dental providers are eligible for prophylaxis cleanings. Patients diagnosed with periodontal disease may require periodontal therapy and procedures, which have higher fees than prophylaxis cleanings. Program Fees apply to procedures performed by or under supervision of a Sage Dental general dentist or as specified on the fee schedule. Specialist services and fees are not included in the Program unless otherwise noted. Eligibility and Sage Dental’s Rights regarding Membership. Members must be 18 years old to enroll. Unless otherwise legally emancipated, a parent or guardian signature is required to enroll those under 18 years old. Sage Dental reserves the right to request identification of any member or to request proof of dependency. Sage Dental reserves the right to refuse Program Membership to any person in its discretion for any reason not prohibited by law. The Membership may be revoked and canceled if the member does not comply with Sage Dental policies, including failing to make prompt payment for any procedure or for any Fee when due, failing to pay any cancellation Fee for missing an appointment, or for providing false or misleading information to Sage Dental. All Membership benefits cease on the date Membership is terminated or cancelled. Sage Dental and its providers may refuse treatment to any member who fails to abide by these Program T&Cs, Sage policies, or Sage’s medical/dental recommendations, referrals, or treatment plans. SageCare+ Fee Schedule. Membership benefits are limited to the Fees specified in the SageCare+ Fee Schedule. Program Fees are minimum Fees only and apply only to general dentistry. SageCare+ Fees are reviewed and updated annually. SageCare+ Fees remain fixed and do not increase during each calendar year, except, however, that Sage Dental reserves the right to correct (and adjust) any Fee for billing or clerical errors, without prior notification to members. The applicable Fee for any procedure performed is the SageCare+ Fee in effect at the time each such procedure is started. You should contact Sage Dental or visit mysagedental.com to confirm the current fee for a particular procedure or treatment. Maximum Liability. SAGE DENTAL’S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THE PROGRAM, WHETHER ARISING OUT OF OR RELATED TO BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, SHALL NOT EXCEED THE APPLICABLE MEMBERSHIP FEE PAID BY THE MEMBER FOR THE ONE-YEAR MEMBERSHIP TERM. No Guaranties and Disclaimer of Warranties. Program Services and specific procedures may not be available in every Sage Dental practice. The Sage Dental provider will present a treatment plan based on the member’s clinical evaluation. Procedures vary for each person and with the complexity of the case. A provider’s professional opinion may be that a specialist is required to perform a given procedure. SAGE DENTAL DOES NOT GIVE ANY WARRANTY, EXPRESS OR IMPLIED, AS TO DESCRIPTION, QUALITY, MERCHANTABILITY, FITNESS FOR ANY PARTICULAR PURPOSE, PRODUCTIVENESS, OR ANY OTHER MATTER, FOR ANY SERVICES OR PRODUCT PURCHASED OR RECEIVED BY A MEMBER FROM A DENTAL PROFESSIONAL OR VENDOR THROUGH MEMBERSHIP IN THE SAGECARE+ DISCOUNT PROGRAM. Any complaint regarding professional services shall be directed to the treating dentist and if not resolved then to PatientFeedback@mysagedental.com. Statutory Disclaimers and Disclosures. This Program is NOT insurance or a registered or regulated insurance plan, and reduced Fees under the Program are not insurance benefits. This Program is not a Qualified Health Plan under the Affordable Care Act. The range of discounts will vary depending on the type of provider and service. The Program does not pay providers directly. Florida Residents: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT. Dr. Cindy V. Roark,DN16590 Sage Dental Group of Florida, PLLC, 951 Broken Sound Parkway NW, Suite 250, Boca Raton, FL 33487. Georgia Residents: ADDITIONAL CHARGES MAY BE INCURRED FOR RELATED SERVICES WHICH MAY BE REQUIRED IN INDIVIDUAL CASES. Dr. Cindy Roark, DN013293, Sage Dental Group of Georgia, LLC, 951 Broken Sound Parkway NW, Suite 250, Boca Raton, FL 33487. Information You Submit; Authorizations. When you use our online bill pay, you will need to submit information about yourself and your payment information, such as credit card type, credit card number, and credit card expiration date (your “Bill Pay Information ”), which will be used to process your payment. You are solely responsible for ensuring that the Bill Pay Information you submit is accurate, complete, and current. Company shall have no liability to you or to any third parties as to the accuracy of the information you provide. You also authorize us to share any information you submit to Company, including your Bill Pay Information, with your Sage Dental provider. You acknowledge and agree that we will use certain trusted partners, or third-party vendors to process your payments and manage your Bill Pay Information (the “Third Party Vendors”). You further authorize the Third-Party Vendors processing your payments or managing your Bill Pay Information to receive information about you and your Sage Dental account. Payment Policy. Member must pay all Fees and related expenses in full when each procedure is performed, except for procedures requiring multiple appointments (such as crowns, bridges, and dentures). All appointments scheduled for 90 minutes or more with any dentist or hygienist and all appointments (except consultations) scheduled with any specialist require the member to pay a deposit of 10% of the total Fee for the scheduled procedure(s). Failure to arrive within 15 minutes of the scheduled time for, or failure to give at least 24 hours advance notice of cancellation of, any appointment for any reason will result in a broken appointment Fee charged to the member and may result in forfeiture of any deposit paid for the scheduled procedure or treatment. This payment policy shall prevail over any conflicts in any other terms and conditions relating to treatment or payment in any other Sage Dental document or form or on its website. Payment Authorization and Responsibility. You authorize Sage Dental to charge and/or debit the account submitted with your Bill Pay Information for the charges for services provided by Sage Dental. Sage Dental is not responsible for charges or fees due to insufficient funds or unsuccessful charges or debits associated with your use of the Bill Pay services. You agree to pay Sage Dental for unpaid charges or fees not collected via Bill Pay Information. General Terms. Terms & Conditions Amendments. Program Terms & Conditions (“T&Cs”) and procedures are subject to change, modification, or substitution. Members are responsible for reviewing the current T&Cs on Sage Dental’s website. Members have the right to receive the T&Cs in non-electronic form and may request such by contacting Sage Dental Management, LLC, 951 Broken Sound Parkway NW, Suite 250, Boca Raton, FL 33487, Attention: SageCare+ Loyalty Program. Litigation Costs and Expenses. This Agreement will be construed and interpreted according to laws of the State of Florida. The exclusive venue for any dispute arising out of, or in any way related to, this Program will be the appropriate court in Palm Beach County, Florida, to whose jurisdiction member agrees to submit. The prevailing party in any action will be entitled to an award of its reasonable costs and attorney’s fees incurred. Assignment. Member cannot assign or transfer his/her Membership in the Program. Severability. If any provision is held illegal, invalid, or unenforceable under present or future applicable law, such provision will be fully severable, and the remaining provisions will be construed and enforced to fullest extent of the law. Headings. The headings identifying the sections and subsections are for reference only and do not define, modify, expand, or limit any of the Program terms or provisions. By signing or accepting the terms digitally and paying the applicable Membership Fee, member enrolls himself/herself and any other designated individuals into the Program, and agrees to the Program’s Terms and Conditions. FIND A DENTIST SUPPORT Connect with us: COPYRIGHT © 2021 – SAGE DENTAL MANAGEMENT, LLC. ALL RIGHTS RESERVED WEBSITE ACCESSIBILITY COOKIE POLICY PRIVACY POLICY TERMS OF SERVICE DISCLAIMERS