Group Dental Scheme Application

By completing this form the details contained in this application will be passed to our MDDUS Solutions team for review. A Sales team member may be in touch, using the details you have provided, to discuss your application with you.

Required start date of Dental Group Name of Practice Address Country Contact name / Practice Manager Business Tel No. Email address Practice NHS Code (if applicable)

GDP Details

How many GDPs work in your practice / group? Please provide the following details for each GDP in your group/practice: full name; GDC number; email address; MDDUS membership/policy number; policy expiry date. How many of the GDP's in your practice/group do you expect to join the Dental Group Scheme? How many Hygienists & Therapists work in your practice / group? Please provide the following details for each Hygienist/Therapist in your group/practice: full name; GDC number; email address; MDDUS membership/policy number; policy expiry date.

Dental Nurse Supplement:

We are offering all Dental Group Scheme members the option to purchase indemnity cover for fully qualified and trainee dental nurses employed by, and working in your practice. This supplement provides access to claims-made indemnity which means that they are eligible for assistance for events that are notified while you are a corporate member. Indemnity offered by MDDUS extends to legal fees and defence costs incurred in respect of claims, as well as expert advice, support and representation in respect of: complaints from patients and their relatives about care delivered by them; General Dental Council (“GDC”) investigations; coroner’s inquests or fatal accident inquiries; certain criminal matters related to dental practice.

Does the Group or Practice require a quote for Dental Nurse cover? yes no How many Dental Nurses are employed by and working within the group or practice?

Billing

When joining the Dental Group Scheme you have two options for how the group will be billed:

Centralised Billing – Where the group/practice are collectively billed for the total cost of the group scheme cover via a single point of contact for the group.

Individual Billing – Where every individual of the group is billed for their own portion of the group scheme cover.

Please select the billing option you would like for the group: Centralised Billing Individual Billing

Looking to protect your business?

Already have Dental Corporate Clinical Indemnity cover? Please tell us your reference number

You can protect your business against clinical malpractice claims where the business is named or could be held vicariously liable for.

Please tick the box if you would like a quote or more details about Dental Corporate Clinical Indemnity. Yes

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