Dentist Enrollment

Thank you for deciding to become a Jersey Shore Discount Dental Plan Provider. Please enter your information below to register with us and begin receiving referrals to your practice.

 

For more information about Jersey Shore Discount Dental Plan you can contact us through our website by clicking here, or email us at info@jerseyshorediscountdentalplan.com, or call us at 732-844-8144.

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Participating Provider Agreement

NOW THEREFORE, the parties do mutually contract and agree as follows: 

I. PROVISION OF SERVICES - A. Dentist and all of it’s employees will be duly licensed to the laws of the state wherein they are practicing dental services specified herein. Dentist specifically warrants that such licenses have never been suspended, revoked, or subjected to any other professional discipline and that said licenses are not currently under disciplinary probation. B. Dentist will provide the dental care services for the discount rate specified in the plan attached hereto and made a part of this agreement to those members of the plan. This plan is subjected to revision by Jersey Shore Discount Dental Plan upon prior written notice. In the event the fee specified in the plan for a particular service exceeds the fee the dentist would charge a non-member for the same services, Dentist shall charge the Jersey Shore Discount Dental Plan member the lesser fee. Jersey Shore Discount Dental Plan will provide the Dentist with a means of determining member eligibility.
C. Dentist shall receive payment for all fees specified in the plan directly from the member. Jersey Shore Discount Dental Plan has no obligation to pay any part of the Dentists fee for the services rendered to the member. Jersey Shore Discount Dental Plan is not an insurance company, an indemnity/PPO or a healthcare organization, nor is the reduced fee for the service plan underwritten by an insurance company. Dentists shall provide such services to the members with the same schedules, skill, care, and judgment that are provided to all patients in accordance with the standard of care in the community in which he practices. E. It is agreed that the Dentists shall provide such services during his normal working hours. Dentists also agrees that the office will be covered for emergencies during dentist vacations and other times the office may be closed. F. If a member requires specialty treatment for any covered service, Dentist agrees to provide member with the name or names of the appropriate participating specialist in the area supplied by Jersey Shore Discount Dental Plan. In the event the agreement is terminated for any reason, the Dentist shall notify any member currently in treatment or any member seeking further treatment of such termination. Dentist agrees to complete all work in progress at the time of termination. Furthermore, if the Dentist wishes to retain the Jersey Shore Discount Dental Plan member as a patient, Dentist must continue to service that member at the prevailing fees and services schedule for as long as that patient is a member in good standing with Jersey Shore Discount Dental Plan. It is expressly understood that the relationship between the individual members and the Dentist shall be subject to the rules, limitations, and privileges incident to the doctor-patient relationship. The dentist shall be solely responsible without interference from Jersey Shore Discount Dental Plan or its agents, to the member for the advice and treatment, including the right to refuse any individual member. Dentist must notify Jersey Shore Discount Dental Plan immediately of the intention to invoke procedures of this provision.
II. NON­EXCLUSIVE - This agreement is not exclusive in any respect, and Jersey Shore Discount Dental Plan is entitled to enter into similar agreements with any other Dentist. Dentist is also free to enter into similar agreements with other parties or with other groups not represented by Jersey Shore Discount Dental Plan and to maintain Dentist private practice. Dentist may not directly or indirectly solicit Jersey Shore Discount Dental Plan member into other pet service plans.
III. INDEMNIFICATION - A. Dentist herby agrees to hold harmless Jersey Shore Discount Dental Plan, its affiliates, controlling companies, and the agents from and against all claims, suits, demands, actions, liabilities and losses that may arise cut of an alleged malpractice or negligent act or omission to act, caused or alleged to have been caused by Dentist or any of his agents, employees, or partners in the performance or the omission of any professional duty assumed by the Dentist hereunder. This obligation to save and hold harmless Jersey Shore Discount Dental Plan shall be inclusive of all dental services performed, whether scheduled under the plan, under the amendment hereto or under any new plan in which Dentist partakes. Jersey Shore Discount Dental Plan also agrees to hold harmless the Dentist from and against all claims, suits, demands, liabilities and losses that may arise out of any acts or omissions by Jersey Shore Discount Dental Plan under this agreement. Dentist agrees that the names, account numbers, addresses and other data and information of its members constitute trade secrets and warrants and guarantees to forever hold in strict confidence all members’ data given otherwise revealed to Dentist. Dentist warrants not to alter, copy, misappropriate, misuse, transfer, sell, deliver or divulge such member data under any circumstances to anyone other than Dentist employees or agents whose duties require access to such information and then only for the purpose of providing dental services hereunder. The obligations of this provision shall expressly survive any termination of this agreement.
IV. INDEPENDENT CONTRACTOR ­ Dentist is an independent contractor in a performance of this agreement. Notice contained herein shall indicate that Jersey Shore Discount Dental Plan is not responsible or liable for any dental work prescribed or performed by an independent contractor (Dentist).
V. TERM AND TERMINATION - A. This agreement shall commence on the date written below and shall remain in effect for one (1) year and be automatically renewed from year to year thereafter. Dentist must provide 60 day written notice of cancellation of participation in Jersey Shore Discount Dental Plan. B. Any violation of any provision of this agreement by Dentist shall be grounds for immediate termination of this agreement by Jersey Shore Discount Dental Plan, including but not limited to the failure to schedule appointments as provided herein, failure to cooperate with Jersey Shore Discount Dental Plan, failure to maintain the standard of care in accordance hereto. Jersey Shore Discount Dental Plan may also terminate this agreement if it is found that the Dentist is providing unacceptable benefits or services at any time. Jersey Shore Discount Dental Plan shall give the Dentist fifteen (15) days written notice of intent to terminate. Such continuing obligations after termination as set forth herein. C. In the event of termination of this agreement, Dentist agrees to forward to the member’s new Dentist, at the request of the member or new Dentist, all patient records and x rays within a reasonable period of time, which shall be defined as no more than thirty (30) days after Dentist is requested by member or member’s new Dentist to transfer material and a shorter period of time if member’s treatment so requires it.
VI. NOTICES ­ Any notice required or permitted to be given hereunder shall be in writing and shall be served upon the other party personally or by registered or certified mail, postage prepaid. Any notice to Jersey Shore Discount Dental Plan shall be addressed to 2677 Highway 70 Manasquan, NJ 08736 and be addressed to the Dentist at his/her current address on file with Jersey Shore Discount Dental Plan.
VII. NO WAIVER - No waiver of any breach, privilege or provision hereunder shall be constructed as a waiver of any future breach.
VIII. INTEGRATION - This agreement constitutes the entire agreement of the parties and may only be amended in writing signed by the parties and in the case of Jersey Shore Discount Dental Plan, signed only by an officer.
IX. ASSIGNMENT- This agreement may not be assigned by Dentist without the prior consent of Jersey Shore Discount Dental Plan. Jersey Shore Discount Dental Plan may assign its Interest’s and suits under this agreement at its discretion.
X. GOVERNING LAW ­ This agreement shall be interpreted and enforced in accordance with the laws of the state of New Jersey, and any litigation regarding this agreement shall be conducted in New Jersey.
IN WITNESS WHEREOF, Jersey Shore Discount Dental Plan and Dentist have executed this agreement as the date shown below.

I agree to the terms of this agreement.