S M I L E V E T E R A N S ' O B J E C T I V E

OBJECTIVE: VETERANS' SMILE

Serving Military Veterans by financially supporting dental care services that improve Veterans' quality of life.

WE CONNECT RESOURCES

Donors

who want to financially support dental care services for Veterans.

Objective: Veterans' Smile

identifies worthy dental organizations and provides donors with an opportunity to support dental programs of impact.

Dental Professionals

who want to provide services free to Veterans but cannot create programs without adequate funding.

Active military personnel have access to five-star dental care, but veterans do not have access to any dental care through the Veterans Administration (VA). As a result, many of our Veterans can suffer from poor oral hygiene, which can cause systemic disease, lack of self-esteem, and a poor general quality of life.

OBJECTIVE: Veterans' Smile is a 501(c)(3) that plugs this dental "access gap" for our Veterans once they transition out of active duty. We research and identify worthy dental programs and disseminate grants to enable impactful organizations to provide dental care to qualifying Veterans.

To learn more & donate: Kyle Arneson | 773.726.7457

OBJECTIE: VETERANS' SMILE (OVS) PROGRAM ELIGIBILITY AND FAQ'S

AS OF 12/15/21

OVS is a non-profit organization created to fill the gap and dental for the veteran, spouse, and dependents. All dental work is covered. Currently the program is in collaboration with Dental Association of WI. OVS pays the policy for Dental Associates CarePlus insurance program and all co-pays.

Eligibility: Honorably or (General under Honorable) discharged veterans. Program is also available to spouses, dependents, and surviving spouses of veterans. Currently the program is for WI clients only.

Income Requirements: None.

Services Provided: All dental; x-rays, cleanings, extractions, fillings, repair, dentures etc.

Application Process: SELF complete the CarePlus enrollment form, email the form with a DD 214 (military discharge) to Kyle Arneson, karneson2@, 773-726-7457. He will call the enrollees when approved withing 1 week. PLEASE BE PATIENT DUE TO HIGH DEMAND.

Q: Do I need to put an effective date in the top right corner of the application? YES, write an effective date in the top right corner of the form two days from when the form is dated on the bottom of the form.

Q: Do dependents also qualify: Yes

Q: 100% service-connected veterans qualify: No

Q: Do spouses of 100% service-connected veterans qualify: Yes

Q: Do surviving spouses of veterans qualify: Yes

Q: Are you contacting the clients who enroll: 1) Yes, they can call the dental office designated on form and schedule appointment and 2) They will receive a mailing with Care Plus information. Member card the cards will be sent out within a week. All enrollments are entered in the Dental Associates system and when they call to schedule an appointment, the Dental Associates staff will be able to view the information. This will let them know that they are part of the OVS Dental Plan.

Q: Will the Dental Associate offices know of OVS Program when the Veterans call? Yes, they will know when they pull up the account. Please let them know that they can call before they receive a card.

"Because OVS is a WIS Non-Profit (501c3), we are also looking for interested donors to our Mission of providing Veterans dental care, both individuals, and Veteran-friendly Companies, in any amount, please help us make that connection. "If you want to THANK a Veteran for their Service....Invest in their Smile"

To Donate or if you have questions about the program contact Kyle Arneson at karneson2@ or call 773-726-7457 between 8-5pm, M-F.

DENTAL ENROLLMENT FORM

INSTRUCTIONS

1) Fill Out Completely 2) Choose a Dental Office 3) Print Firmly & Legibly

4) Sign and Date this Form 5) Use Pink Copy as Your Temporary I.D. 6) Read Terms and Conditions on Reverse Side

FOR EMPLOYER USE ONLY

EFFECTIVE DATE OF BENEFITS

MO.

DAY

YEAR

EMPLOYER

OBJECTIVE: VETERANS' SMILE

N/A DATE FIRST

WORKED

CONTRACT DESIRED

SINGLE

FAMILY

E+SP E+CHILD(REN)

EMPLOYEE

LAST NAME

FIRST NAME

MIDDLE INITIAL

SEX

DATE OF BIRTH MO DAY YEAR SOCIAL SECURITY NO.

SPOUSE

DEPENDENT CHILDREN

HOME ADDRESS

PRIMARY PHONE

CITY

STATE

ZIP

SECONDARY PHONE

Select a Dental Center

Appleton 4660 W. College Ave.

Appleton - North 2115 E. Evergreen Dr.

Fond du Lac 545 E. Johnson St.

Franklin 6855 S. 27th St.

Green Bay 430 Main St.

Green Bay - Howard 2340 Duck Creek Pkwy.

Greenville N1737 Lily of the Valley Dr.

Kenosha 7117 Green Bay Rd.

Milwaukee - Beerline B 220 E. Pleasant St.

Milwaukee - Downtown 205 E. Wisconsin Ave.

Milwaukee - Miller Park Way 2100 Miller Park Way

Sturtevant 10155 Washington Ave.

Waukesha 1211 Dolphin Ct.

Wauwatosa 11711 W. Burleigh St.

I HEREBY APPLY FOR ENROLLMENT SUBJECT TO THE TERMS AND CONDITIONS ON REVERSE SIDE.

X SIGNATURE

CP-401EF 1116

DATE SIGNED

WHITE & YELLOW COPIES to Employee Benefits Department PINK COPY - Retain for your files.

TERMS AND CONDITIONS

1. All statements and answers in this application are representations made by the member on behalf of himself/herself and other persons named in the application, if any, to induce the insurance of the dental contract applied for.

2. The Applicant, on behalf of himself/herself and other persons named in the application, if any, consents, authorizes and directs any physician, dentist, consultant, hospital or other person or corporation by whom or in which any diagnosis, medical, surgical or dental treatment or advice is being, shall be or shall have been rendered to furnish and make available to Care-Plus Dental Plans, Inc., all such medical, surgical and dental reports, records and other information as they may request, at no cost to them.

3. The contract applied for will become effective only upon the acceptance of this application by Care-Plus Dental Plans, Inc. to be evidenced by the insurance of Identification Card(s) which will be delivered to the Group or to the Member designated herein as the Applicant.

4. The member authorizes the Group as his remitting agent to deduct from his wages or salary a sufficient amount to provide for the regular and timely prepayment of the prevailing subscription fees that are not otherwise contributed for the contract applied for, and to remit the same for him and on his behalf to Care-Plus Dental Plans, Inc. as specified in the agreement between Care-Plus Dental Plans, Inc. and the Group.

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