For Eligible Participants of the UFCW Local 1776 and Participating
Employers Health and Welfare Fund

MISSED/CANCELLED APPOINTMENTS
When you schedule an appointment with your dentist, that time is reserved for you. If you miss or cancel a dental appointment with less than 48 hours notice, the participating dentist may charge you a $10.00 fee for basic services, or a maximum $25.00 fee if supplemental services were scheduled for that missed appointment. This fee is your responsibility; it is not covered under the Plan. Any fee charged by a non-participating dentist for a missed/cancelled appointment is also not covered under the Plan.