Dental Benefit Plan Williamsburg - Morrison Dental Group

THE MORRISON DENTAL GROUP BENEFIT PLAN

“Trust Your Smiles to Us”

Dental coverage for as little as $27 per person per month!

The MDG Dental Benefit Plan was developed primarily to provide affordable, quality dental care to our community. Our philosophy at MDG allows our team of professionals to deliver excellent care and superior customer service. We invite you to apply for this opportunity to become a part of our dental family.

The MDG Benefit plan is ideal for:

Individuals & Families
Retirees
Small Businesses
Self-Employed
Anyone without dental coverage

Patients have the opportunity to select between the silver and gold plans. All plans include:

2 cleanings per plan year
2 periodic exams per plan year
1 problem focused exam per year
4 bite wing x-ray films per plan year
2 periapical x-ray films per plan year
1 full mouth x-ray (usually taken every 3-5 years)
2 fluoride treatments per plan year for children up to age 15

Members of both plans will receive a courtesy fee reduction on services as described below. In addition, MDG Dental Benefit Plan members will receive a courtesy fee reduction with our affiliate specialists.

Service	Silver Plan	Gold Plan
Sealants	50%	50%
Fillings	15%	20%
Oral Surgery	15%	20%
Root Canals	15%	20%
Periodontics	15%	20%
Crown & Bridge Services	10%	20%
Partials/Dentures	10%	20%
Implant Services	10%	10%
6 Month Smile	$350 Off	$500 Off
Clear Correct	$450 Off	$600 Off
Additional Flouride Treatments	0	2
Additional Hygiene Care Visit	0	1
Additional Oral Cancer Exam	0	1

Plan costs per year:

Coverage	Silver	Gold
Single	$325	$425
Dual	$625	$800
Family (3)	$850	$1,200
Family (4)	$1,175	$1,575
Additional	$300	$400

For more information contact our office regarding the Wells Fargo Health Advantage or Care Credit interest free financing.

Average Preventive Value: $594.00 per person

*Total payment is due at the start of each membership year*

$25.00 one time application fee per person

$50.00 maximum application fee per family

Prices effective January 1, 2025

APPLY TODAY

You can apply in one of three ways. Chincoteague patients, please call or visit our office to apply.

BY MAIL*: Click HERE for a printable PDF application. Fill out your information then, mail the application to the below address or drop it by one of our offices. You can pay by check or credit card at the office, or by credit card over the phone.
Morrison Dental Group - Benefit Plan Specialist
1131 Professional Drive
Williamsburg, VA 23185
(757) 208-0992
IN PERSON OR BY PHONE*: Come visit us at our offices or call us at (757) 208-0992. You can pay by check or credit card at the office, or by credit card over the phone.
ONLINE*: Use the form below. We will call you for your credit card payment information.

THE MORRISON DENTAL GROUP BENEFIT PLAN APPLICATION

Name*
First Last
Middle Name or Initial
Social Security Number*
Home/Cell Phone*
Home Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Date of Birth*
Gender*
You Are*
If Employed, Company Name
If Employed, Job Title
APPLY FOR FAMILY MEMBERS LIVING IN THE SAME HOUSEHOLD. COST IS $264 PER PERSON PER YEAR. ALL REQUESTED INFORMATION IS REQUIRED. THANK YOU!
Family Member #1

Please include: First and Last Name - Social Security # - Cell Phone (if applicable) - Email - Date of Birth - Gender - Employed/Self-Employed/Retired/Student
Family Member #2

Please include: First and Last Name - Social Security # - Cell Phone (if applicable) - Email - Date of Birth - Gender - Employed/Self-Employed/Retired/Student
Family Member #3

Please include: First and Last Name - Social Security # - Cell Phone (if applicable) - Email - Date of Birth - Gender - Employed/Self-Employed/Retired/Student
Family Member #4

Please include: First and Last Name - Social Security # - Cell Phone (if applicable) - Email - Date of Birth - Gender - Employed/Self-Employed/Retired/Student
Family Member #5

Please include: First and Last Name - Social Security # - Cell Phone (if applicable) - Email - Date of Birth - Gender - Employed/Self-Employed/Retired/Student
Do You Have a Coupon Code?
- Yes
- No
Coupon Code
Acknowledgement and Signature*
- By submitting this form I acknowledge that I am 18 years of age or older, or have permission from my parent/guardian to apply to this program.
- By submitting this application, I acknowledge that I have read over the fees and payment requirements. I know and understand that should I enroll with Morrison Dental Group Benefit Plan, I will be responsible for paying my fees in full via an agreed upon payment method.

*Please note:

Members must pay the application fee and membership fee prior to receiving a membership card.
Cannot be used for purchase of dental retail products.
Total payment amount is due at time of service. If full payment is not received at time time of service, fee reduction will be void.
Cannot be combined with any other dental insurance or discount.
Payment is due at the start of each membership year.
Courtesy fee reduction or included dental services are non-transferable.
Fee Reduction does not apply to Morrison Migraine Center.