Dental Membership Program 2018-09-13T17:05:51+00:00

Dental Membership Program

Registration Form
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Coverage Includes

100% Covered Procedures

  • Comprehensive Exam (new patients/initial exam)
  • Periodic Exam 2/yr
  • Limited Oral Exam 1/yr
  • Complete Set of X-rays 1 every 3 years
  • Bitewings X-rays 1/yr
  • Child Prophylaxis 2/yr
  • Adult Prophylaxis 2/yr (non periodontal patients)
  • Periodontal Patients (2 Perio Maintenance Appointments at 15% off) (Any additional Perio Maintenance Appointments at 50% off)
  • Fluoride up to 23 y/o 2/yr

All Other Procedures

  • Fillings and Buildups 20% off
  • Sealants 50% off
  • Crowns 20% off
  • Veneers 20% off
  • Dentures and Partials 15% off
  • Extractions 20% off
  • Root Canals 20% off
  • Sleep Apnea 20% off
  • Additional X-rays 20% off

*Must remain in Dental Plan during the entire duration of the orthodontic treatment plan to retain benefits.

Yearly Plan Cost

Single Member: $219.00
Dual Member: $399.00
Additional Member: $99.00

*The Dual Membership is for Parent/Child or Husband/Wife only.

get started today • Call 815-561-6058

Dental Limitations and Exclusions

  • Services that, in the opinion of the attending dentist, are neither necessary nor recommended for the patient’s dental health.
  • Restorations, splints or other appliances used to increase vertical dimension or restore occlusion.
  • Oral surgery requiring the setting of fractures or dislocations.
  • Treatment of malignant cysts or neoplasms or congenital malformations, except that teeth congenitally missing or congenitally malformed are covered for replacement and/or restoration.
  • Dispensing of drugs not normally supplied in a dental office.
  • Hospital benefits for any dental procedure.
  • Loss or theft of dentures or bridgework.
  • Nightguards are excluded
  • Laser Curettage are excluded
  • Any experimental procedures
  • Services for injuries or conditions that are covered under Worker’s Compensation or Employer’s Liability laws.
  • Services that are provided without cost to the member by any municipality, county or other political subdivision.
  • Services that cannot be performed because of the general health, physical or psychological limitations of the patient.
  • Periodontics, endodontics, oral surgery or pedodontics requiring the services of a non-participating dentist.
  • General anesthesia or nitrous oxide
  • Those procedures requiring appliances or restorations that are necessary for full mouth rehabilitation, or to alter, restore or maintain occlusion, including without limitation, treatment of disturbances of the temporomandibular joint.
  • Diagnosis and treatment of myofascial pain dysfunction syndrome
  • Procedures performed in the hospital cannot be used with other dental discount plans or special offers.
  • Demonstrated non-compliance with recommended course of treatment may result in cancellation.

Orthodontic Limitations and Exclusions

  • Braces are included on the Membership Program for adults and children at a 10% discount.
  • Invisalign is excluded
  • Treatment programs that began before the member enrolled in the plan are not discounted nor can they be transferred to the Dental Membership Program.
  • Lost or broken appliances are not subject to replacement.
  • Additional fees may be charged by the dentist for: gross and consistent non-cooperation by the patient/member, accidents occurring during the treatment, cases involving surgical orthodontics, cases involving myofunctional therapy, temporomandibular joint treatment, loose, broken or lost bands, brackets, or appliances.
  • If the member relocates to an area and is unable to receive treatment from a participating dentist, membership under this program ceases and becomes the obligation of the patient/member to pay the usual and customary fee of the non-participating dentist at whose facility treatment received prior to relocation.
  • Choice of dentist, initially, after treatment begins or upon change of residence is limited to practitioners participating in this program or who accept fees outlined.

About The Program

Shady Oak Dental plan is a reduced-fee dental membership plan that allows individuals and families to receive quality dental services from Shady Oak dentists for reduced prices. We have offices conveniently located in Forreston, Freeport, Mokena and Savana Illinois. You, your spouse, dependent children up to 23 years of age, and children over 23 with a developmental disability or physical handicap are eligible. Individuals under the age of 18 may only be members as the dependents of adults.

This discount program is NOT a health insurance policy and does not make payments directly to dental services providers. Members are obligated to pay for all dental services at time of service, but may receive discounts on dental services from participating providers and the discount range will vary depending on the provider type and dental services received. The program does not meet the minimum creditable coverage requirement under any law and is not a Qualified Health Plan under the Affordable Care Act. If you cancel within the first 30 days after activation you will receive a full refund if no dental services were received. Program administered by Shady Oak Dental, LLC, 208 North Walnut Street, Forreston, IL 61030, (815) 821-9249. Members who cancel after receiving benefits may be liable for the difference between the membership fee and the provider’s normal and customary fee for treatment, payable to the provider.

Members may change or add additional family members by providing a written request and paying any additional membership fees. Changes will be effective 30 days from the receipt of written Oak Dental Membership Plan Customer Service, PO Box 368, Forreston, IL 61030. Complaints will be addressed within 30 days of receipt.


There’s no ID card, no group or member number to bring! All your membership information will be kept in your electronic record. Your effective date is the day you sign up and your renewal date is the same date every year.