Discount Dental Plan Plus Options Form

Dental Option

(N/A in KS, UT, WA, VT) Includes Dental, Vision, Pharmacy, Vitamins and Diabetic Supplies

Optional Benefits

Speak to a US Board Certified Doctor with an average of 20 years experience anytime of the day completely free of charge. Save time and money by avoiding crowded waiting rooms in the doctor’s office, urgent care clinic or ER. Just use your phone, computer, smartphone or tablet to get a quick diagnosis. Medications prescribed when medically necessary and called in to your pharmacy of choice.

Includes the following: Pet Care: Includes savings on all Veterinarian Services, pet medications, pet boarding, pet sitting, pet food and more. All household pets are included. Tax Helpline: Free Tax Preparation (1040, 1040EZ, 1040A), Year around tax support, discounts on other tax forms, more. Financial Helpline: Free confidential financial advice and planning by accredited or certified financial counselors

Includes Towing Assistance, Battery Service, Flat Tire Service, Fuel, Oil, Fluid and Water Delivery Service and Lock Out / Lost Keys Services.

Includes Identity Restoration / Alerts, Document Replacement / Recovery, Credit Inquiry Alerts, 1 Bureau Credit Report / Score Monitoring, Bank Account / Credit Card Monitoring, Expense Reimbursement Benefits

Free Legal Services Include: Attorney Consultations, Attorney Phone Calls on your behalf, Help with Legal Documents, Representation in Small Claims Court, Assistance with Welfare and INS and a Simple and Living Will. Attorneys only charge $125 an hour or 40% off their hourly rate, whichever is greater. 10% off all contingency-based cases

Free Legal Services Include: Attorney Consultations, Attorney Phone Calls on your behalf, Attorney Review of Business Documents, Business Letters and Collection Letters Written by an Attorney on your behalf, Registered Agent Services. Attorneys only charge $125 an hour or 40% off their hourly rate, whichever is greater for additional services.

** Coupon Applied: $10.00 Processing Fee Waived


Explanation of Program and Disclosures

I wish to join the AHB dental plan. Actual savings will vary depending on the region and the type of specific services provided. AHB savings programs cannot be used in conjunction with any similar style program. All listed or quoted prices or fees are current prices at the date of publication and are subject to change. The AHB program benefits may vary in some areas and the program and providers may be modified at any time.

Effective Date: The first of the month, after the month in which you enrolled.

Your member instruction guide and cards should be arriving in approximately 7 to 10 business days.

Billing: An automatic draft on the 5th of every month from a checking or credit card of your choice.

Members may cancel their AHB program at any time upon notice via phone, mail, email or fax. Request to cancel must be received 5 business days in advance of the next billing cycle for Member not to be charged for that billing cycle, if the notice of cancellation is not received prior to the billing cycle, then cancellation of payment will occur at the next billing cycle. Cancellations within the 1st 30 days of the program are eligible for a refund of member fees excluding the one-time processing fee.

This plan provides discounts at certain healthcare providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization

Dental Benefit is not available to VT residents. The discount program provides access to the Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its affiliates offers or administers the discount program. Neither ALIC nor any of its affiliates is an affiliate, agent, representative or employee of discount program. Dental providers are independent contractors and not employees or agents of ALIC or its affiliates. ALIC does not provide dental care or treatment and is not responsible for outcomes.