Back to Main Site Gold Plan Application Overview Your Info Location Plan Type Payment Info Review Information about the Gold Plan Comfort Dental Gold Plan is a reduced-fee dental membership plan that allows individuals and families to receive quality dental services from Comfort Dental dentists at reduced prices. The Gold Plan offers the access of a network, plus the individualized attention of private care. You, your spouse, dependent children up to 26 years of age, and children over 26 with a developmental disability or physical handicap are eligible. Individuals under the age of 18 may only be members as the dependents of adults. Members must choose a provider/office from the list of OFFICE LOCATIONS provided in this form. Provider information is also available at www.comfortdental.com or by calling the Gold Plan office. To receive care, simply call your selected office for an appointment after your effective date. All Comfort Dental Offices offer EVENING AND SATURDAY appointments. The Gold Plan is a yearly membership with the option to pay membership fees monthly or annually. Members who enroll prior to the 10th of the month will have their membership begin on the first day of the following month. Those enrolling after the 10th will have their membership begin on the first day of the second month. This discount program is NOT a health insurance policy and does not make payments directly to dental service providers. Members are obligated to pay for all dental services, but may receive discounts on dental services from participating providers and the discount range will vary depending on provider type and dental services received. The program does not meet the minimum creditable coverage requirements under any law and is not a Qualified Health Plan under the Affordable Care Act. If you cancel within the first 30 days after activation you will receive a full refund, except for the $10 processing/enrollment fee where permitted by law. Administration Comfort Dental’s Gold Plan program is administered by: Comfort Dental Gold Plan, LLC 2540 Kipling St., Lakewood, CO 80215 (303) 232-2300 855-526-6524 goldplan@comfortdental.biz Members who cancel after receiving benefits may be liable for the difference between the Gold Plan fee and the provider’s normal and customary fee for treatment, payable to the provider. Members may change providers or add additional family members by providing a written request and paying any additional membership fees. Changes will be effective 30-days from the receipt of written requests. Feedback Complaints should be addressed to: Comfort Dental Gold Plan Complaints 2540 Kipling St., Lakewood, CO 80215 Patient Relations Email - asiudyla@comfortdental.biz Complaints will be addressed within 30-days of receipt. If a member remains dissatisfied he or she may contact his or her state’s insurance department. The Gold Plan does not guarantee the quality of the services or products offered by individual providers. Gold Plan Inclusions Gold Plan Membership provides you with local anesthetics, examinations, x-rays, and other preventive services at NO CHARGE ($5.00 for Arizona members) plus reduced fees on most other dental services. The Reduced Fee Schedule is included and can also be viewed at www.comfortdental.com/patient-center/gold-plan/ for full details on discounted services. Members are charged an office visit fee of $25.00 for each appointment. Orthodontics (BRACES) are provided at $129/month for children and $139/month for adults with NO DOWN PAYMENT. The reduced fees are paid directly by you to your selected provider. A complete list of dentists and offices is available at www.comfortdental.com. Members may receive emergency dental care for the relief of pain, bleeding or swelling from any Comfort Dental dentist at any Comfort Dental office when their selected provider is unavailable. This contract is not protected by any state guaranty fund. The program and program administrator is not liable for providing or guaranteeing health services or for the quality of health services rendered. Membership and activation fees apply. The Gold Plan is governed by this Membership Agreement. Participating providers are not available in all areas and are subject to change without notice. Program is not available in all states. I understand the benefits, limitations, exclusions and requirements of the Plan and I agree to the following: I will remain in the plan and pay membership fees for 12 months. Where permitted by law, payment of less then 12 months’ membership fees may result in my being charged usual and customary fees for all services (including those already provided) and my being charged remaining months’ fees in a lump sum. Fees for dental services are due to the dentist as services are rendered. Fees for prosthodontic and case restoration services are due to the dentist at the preparation/impression visit. Failure to comply may result in my being charged usual and customary fees for such services. I agree to pay any and all costs in collecting all charges, including but not limited to attorney fees and court costs. Membership must be continuous. Missing monthly payments must be made up for interrupted membership. Processing fees are not refundable. I accept these Terms of Service Continue Monthly Membership Fees* Individual Member $10.50 ( 1st month charge is $21.00 which includes 1st & last month) Member and One Dependent $17.50 ( 1st month charge is $35.00 which includes 1st & last month) Member and up to Three Dependents $24.50 ( 1st month charge is $49.00 which includes 1st & last month) Member and Four or More Dependents $29.50 ( 1st month charge is $59.00 which includes 1st and last month) * Monthly mail-in payments are charged an extra $10.00 per month. Annual Membership Fees* Individual Member $136.00 (includes $10.00 processing) Member and One Dependent $220.00 (includes $10.00 processing) Member and up to Three Dependents $304.00 (includes $10.00 processing) Member and Four or More Dependents $364.00 (includes $10.00 processing) Limitations and Exclusions Dental Orthodontic Reduced Fee Schedules Colorado, Nebraska, Oklahoma & Ohio Arizona Kansas, Missouri New Mexico Texas Contact Privacy Policy Copyright All Rights Reserved © 2021 - Services provided by a state licensed general dentist or orthodontist.