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Billing Statement and Summary of Benefits

Control your Cooperative communication.

In an effort to save waste and go paperless (and yes, avoid paper cuts too), the Dental Cooperative allows our members to choose how they receive their Billing Statement and Summary of Benefits. You can get them anyway you need them by simply completing the form below. Don’t forget to tell us to whom you want them sent.

BILLING STATEMENT AND SUMMARY OF BENEFITS

*required

Practice Information:








Monthly Billing Statement

In an effort to save waste and go paperless, the Dental Cooperative now sends monthly billing statements out only upon request. The monthly billing statement reflects your Cooperative membership fees for the month. Since this is already reflected on your credit card or bank statement, most Members consider this statement unnecessary. If you would like to receive a monthly billing statement, we are happy to do that for you. Please complete the following information:


Monthly Billing Statement



You may choose up to 2 contacts.










Summary of Benefits

As with the billing statement, in an effort to save waste and go paperless, the Dental Cooperative now sends Summary of Benefit out quarterly.The Summary of Benefits is a snapshot of the Cooperative programs your practice is currently using and programs available to use. Keep in mind that you can request your current Summary of Benefits anytime from your Area Director. The Dental Cooperative automatically send out your Summary of Benefits every quarter in February, May, August, and November. If you would like to receive your Summary of Benefits monthly, please check the box below:


Monthly Summary of Benefits



You may choose up to 2 contacts.














Once submitted, we will make the changes in our database. If you would like to change your preferences, you can contact your Area Director anytime to make the changes.