$72.00
Per Year (Auto Renewed)

I hereby submit my application to enroll in the Tennessee Dental Plan.  I hold the Tennessee Dental Plan blameless for negligence on the part of any participating provider.  I accept liability for all payments due to Tennessee Dental Plan up to and until I cancel the plan. I understand that I must cancel my account at least 30 days prior to the date of my next drafting. I also understand that my account may be canceled by Tennessee Dental Plan at any time due to unavailability of funds or inaccessibility of my account.  No refunds will be issued.

$96.00
Per Year (Auto Renewed)

I hereby submit my application to enroll in the Tennessee Dental Plan.  I hold the Tennessee Dental Plan blameless for negligence on the part of any participating provider.  I accept liability for all payments due to Tennessee Dental Plan up to and until I cancel the plan. I understand that I must cancel my account at least 30 days prior to the date of my next drafting. I also understand that my account may be canceled by Tennessee Dental Plan at any time due to unavailability of funds or inaccessibility of my account.  No refunds will be issued.

$120.00
Per Year (Auto Renewed)

I hereby submit my application to enroll in the Tennessee Dental Plan.  I hold the Tennessee Dental Plan blameless for negligence on the part of any participating provider.  I accept liability for all payments due to Tennessee Dental Plan up to and until I cancel the plan. I understand that I must cancel my account at least 30 days prior to the date of my next drafting. I also understand that my account may be canceled by Tennessee Dental Plan at any time due to unavailability of funds or inaccessibility of my account.  No refunds will be issued.