To begin the dental plan application process, PRINT THIS FORM, fill it out, and mail it along with your enrollment fees.  You will receive your membership packet by return mail. For immediate enrollment call (888) 380-6337 during regular business hours.

  Yearly Enrollment Fees

• $55 yearly enrollment fee per individual

• $90 yearly enrollment for two

• $125 yearly enrollment for three

• $155 up to six people

Save Money On Your Yearly Enrollment...To save money on your yearly dental enrollment fees, sign up additional people with the first enrollment.  For instance, up to six people can enroll for $155.   They don't have to live at the same address, nor do they have to be related. That brings down the yearly enrollment fee to a little more than $25 per person (saving nearly 50%).  Enrollments packages can include family, friends, co-workers, neighbors or anyone without dental insurance who may need dental coverage.  

 

Mail enrollment form and fees to the following.

Medical Discounts International
322 Paseo Tesoro
Walnut, CA 91789
 

Affordable Dental Plan Enrollment Form
Name of Primary Member:
Mailing Address:
City, State, Zip:
Telephone:
Date:
Email Address:
Names of additional family members to be included in the plan.
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