Must be a MDIS client with an active policy to login. Once logged in, can use the web portal or app to upload secure documents to MDIS.

To register, clients must provide three pieces of information: 

1. Email address
2. Phone number 
3. Policy # (any active MDIS policy #; once in portal, ALL policies associated with your account will load)

To successfully login, email and phone entered must match that MDIS has on file for a client. If you have questions or need assistance, follow on-screen prompts or contact MDIS. Once you enter information that matches the MDIS system, you will receive an email confirmation code and then can create a username and password.

Introduction

By clicking the “I Agree To Electronic Delivery” checkbox in the submission form below, you are providing consent to Missouri Dental Insurance Services (Agency) to provide documents to you electronically on behalf of the Agency, the insurance companies represented by the Agency, and other third parties. All documents sent by Agency to you are subject to this Consent Form, including but not limited to, any and all disclosures, declarations, contracts, policy forms, certificates, and/or documents, information, requests, applications, communications, and/or notices required by federal law, except when applicable law requires notice by another means. You agree that electronic delivery of documents is sufficient to meet all reporting and/or notice requirements, except when applicable law requires notice by another means. You are not required to receive documents electronically. Your agreement to accept documents electronically means that once Agency delivers a document to you, and if required, you click to accept the document, the terms contained in the document apply to you. Additionally, it means that Agency may not mail you copies of documents that are provided electronically. You must print or otherwise retain a copy of this consent form for your records.

If you do not agree to this Consent Form, please click the “I Do Not Agree To Electronic Delivery” in the submission form below, and Agency will provide documents in accordance with applicable law.

Documents to be Provided by Electronic Delivery

Documents that may be delivered to you by electronic delivery include Policy Documents, Billing Documents and other Documents. Those terms have the following meanings in these Terms and Conditions. Policy Documents, Billing Documents and Documents have the following meaning in these Terms and Conditions:

Policy Documents means: insurance policies, policy jackets, endorsements and declarations pages, renewal declarations pages, privacy policy, important notices, policy id cards, change declarations, consumer bills of rights, newsletters, information about your policy, underwriting documentation, applications, questionnaires, surveys, and any other documents related to your insurance as we may determine.

Billing Documents means: bills, billing notices, billing related disclosure notices not sent with the policy, information about your bill or payment and any other documents related to your bill or payment as we may determine.

Document means: Policy Documents, Billing Documents or both.

Currently, some types of Documents are not available for Electronic Delivery. We will continue to Mail those Documents to you. However, some or all of those Documents may become available for Electronic Delivery in the future. When Documents become available for Electronic Delivery, we may automatically start sending those Documents by Electronic Delivery and stop Mailing those Documents to you, without any further notice. Your consent to Electronic Delivery applies both to Documents that are currently available for Electronic Delivery and to Documents that may become available for Electronic Delivery in the future.

Electronic Delivery of Documents 

When Agency delivers a document electronically, it will do so by making the document available to view by sending the document by email. You should check your email periodically to ensure timely receipt of any document delivered electronically. A document will be considered delivered to you when the emailed document leaves Agency’s system. To be clear, a document is not considered delivered based on when you review the document. Upon request any documents you request can be delivered via your secure online client portal for you to access.

The receipt of documents electronically has security and privacy risks. Email and on-line security and privacy cannot be guaranteed, and emails can be intercepted without your permission. If you agree to this Consent Form, you acknowledge and agree to accept these and other risks of receiving documents electronically.

Hardware and Software Requirements

Before agreeing to receive documents electronically, you must determine whether you have the necessary hardware and software to access and retain documents electronically. To access documents, you will need an email address, Adobe Acrobat Reader, or any other program capable of reading documents saved in PDF format and a personal computer or other personal device that is capable of accessing the internet. To retain documents, your access device must have the ability to download to your hard drive, or an external media storage device, or to print the documents, as well as embedded HTML files. If you are unable to access a document electronically, you are obligated to notify Agency immediately by phone at 573-636-8752 or by email to info@mdis4dds.com

Delivery and Receipt of Documents in Paper Form

You have the option to request that Agency provide you with paper copies of the documents Agency provides to you electronically. If you wish to obtain a paper copy of a document, you may send an email request to info@mdis4dds.com or a written request to 3340 American Ave, Ste E. Jefferson City, MO 65109. You will not be charged for paper copies of a document. Declining to receive documents via e-delivery will not enroll you to automatically receive the documents via mail.

Moreover, even if you consent to receive documents electronically, Agency may choose, in its sole discretion, to send paper copies of documents to you even though the documents were made or could have been made available to you electronically. Such delivery will be provided to you at the most current mailing address on file. Changes to your mailing address can be made as stated in the section below.

Right to Withdraw Consent and Procedures for Withdrawal

You may withdraw your consent to receive documents electronically, at any time and without charge, by sending an email request to info@mdis4dds.com or a written request to 3340 American Ave, Ste E. Jefferson City, MO 65109. Withdrawal of your consent shall not affect the legal effectiveness, validity, and/or enforceability of documents provided or made available to you electronically prior to implementation of your withdrawal of consent. Your withdrawal of consent shall be effective within ten (10) days after receipt by Agency of your withdrawal request. Thereafter, such delivery will be provided to you at the most current mailing address on file. Changes to your mailing address can be made as stated in the section below.

Authority to Access to Documents Delivered Electronically

You are the only individual authorized to access your documents from Agency electronically. You shall take all reasonable measures to protect your access devices to prevent unauthorized access to documents delivered electronically.

Prompt Notification of Changes

You agree to notify Agency promptly of any changes to your mailing address, email address, or other information. Notification may be by email to info@mdis4dds.com, in writing to 3340 American Ave, Ste E. Jefferson City, MO 65109, or by telephone at 573-636-8752. You agree to hold harmless Agency in connection with your failure to provide current and valid contact information.

By clicking the “I Agree To Electronic Delivery” checkbox in the submission form below, you confirm that you have read and understood this Consent Form in its entirety, that you consent to the electronic delivery of documents by Agency on its behalf and on behalf of insurers, that your hardware and software systems meet the requirements set forth herein, that you are able to access and retain documents presented to you on a portal or via email, and that you have printed or stored. a copy of this Consent Form.

If you do not agree to the terms of this Consent Form, please click the “I Do Not Agree To Electronic Delivery” checkbox in the submission form below.

 

MDIS Client Opt-In For Text Messaging

The undersigned client (“You”) consents to receive text messages from Missouri Dental Insurance Services, Inc (MDIS) (the “Agency”) or others acting on the Agency’s behalf. As part of this consent, you represent and warrant the following:

(1) The Agency or others acting on the Agency’s behalf may send text messages in various formats and with various contents, including but not limited to, text messages about insurance policies and other transactions initiated by You or marketing the products and services offered by or through the Agency.

(2) You are the owner or authorized user of the mobile phone number identified below. You will notify us immediately if you are no longer the owner or authorized user of the mobile phone number identified below.

(3) You are solely responsible for any message and data charges associated with such text messages.

(4) The Agency has made its Text Messaging Terms and Conditions (“Terms and Conditions”) available to You (below) and will provide You with a hardcopy of the Terms and Conditions upon request. By agreeing to this opt-in form, you agree to the Terms and Conditions.

(5) If you wish to opt-in click the “I Agree To Electronic Delivery” checkbox in the submission form below, after which you will receive an initial text message to the mobile phone number below asking You to confirm your consent with a YES or NO response.

If You do not wish to receive text messages from the Agency or others acting on the Agency’s behalf, or do not agree to the Terms and Conditions, you should not sign this form.

Terms & Conditions For SMS/Text Messaging

Please read these SMS/Text Messaging Terms & Conditions carefully. By completing the SMS/Text Messaging Opt-In Form, you expressly consent to receive non-marketing and marketing text messages from Missouri Dental Insurance Services, Inc (MDIS) (“Agency”), including text messages made with an Autodialer, at the mobile phone number(s) you provide.

You may opt-out of these communications at any time by replying STOP to any text message from Agency or by otherwise contacting Agency as indicated below. You can receive help at any time by replying HELP to any text message from Agency or by otherwise contacting Agency as indicated below. Consent to receive non-marketing or marketing text messages is not required to purchase any products or services from Agency. Messaging and data rates may apply.

By completing the SMS/Text Messaging Opt-In Form, you also accept and agree to be bound by these SMS/Text Messaging Terms & Conditions and any other applicable terms and agreements related to your use of Agency services.

Program Description

Agency offers its text messaging program whereby Agency, and any applicable service providers, will text message you to provide you with information concerning your account activity with Agency and other Agency products, services, and promotions (all of the foregoing the “Agency Program”). Agency and its service providers may, from time to time, use standard or an automatic telephone dialing system (“Autodialer”) to deliver text messages to you under the Agency Program. You agree that you will not use the Agency Program for any illegal or unlawful purposes. No coverage may be bound or amended via text message or the Agency Program.

Message Frequency

Under the Agency Program, the number of Agency text messages that you receive may vary depending upon your account activity and your communication with Agency.

Cost

Agency does not impose a separate fee for sending Agency text messages under the Agency Program. However, standard message and data rates may apply to each text message sent or received in connection with the Agency Program, as provided in your mobile telephone service rate plan. Please contact your mobile telephone carrier for pricing plans and information.

Supported Carriers; Interruption

The Agency Program should be available through your equipment or mobile device when the equipment or device is within the operating range of your wireless service provider. The Agency Program may not be available on all equipment/mobile devices, or through all wireless carriers, and not all functionalities of the Agency Program are available on all equipment/mobile devices, or through all wireless carriers. Agency may, from time to time, in its discretion and without notice to you, limit the carriers that support the Agency Program. Certain other carriers may not support the Agency Program.

Delivery of information and content to your equipment/mobile device may fail due to a variety of circumstances or conditions. The Agency Program is subject to transmission limitation or interruption. You understand and acknowledge that mobile network services are outside of Agency’s control, and Agency is not responsible or liable for issues arising therefrom, or the failure thereof, including, without limitation, technical, hardware, software, electronic, network, telephone or other communications malfunctions, errors or failures of any kind, errors in transmission, traffic congestion, lost or unavailable network connections, telephone connections, wireless phone connections, website, Internet, or ISP availability, unauthorized human intervention, traffic congestion, incomplete or inaccurate capture of entry information (regardless of cause) or failed, incomplete, garbled, jumbled or delayed transmissions which may limit or restrict your ability to receive or send a message, including any injury or damage to your or any other person’s equipment/wireless device relating to or resulting from participating in or using the Agency Program. If the Agency Program is not available within your intended location, you agree that your sole remedy is to cease using the Agency Program.

How to Opt-In

To opt-in to receive text messages from Agency under the Agency Program, complete the SMS/Text Messaging Opt-In Form and submit it to Agency. Agency will then send you a text message asking you to confirm your enrollment in the Agency Program.

How to Opt-Out

To stop receiving text messages from Agency, text STOP to the ten-digit long code from which the text messages are being sent. You will then receive confirmation of your opt-out of the Agency text messaging program. You may also opt out by providing written notice to Agency at MDIS, 3340 American Avenue, Ste. E, Jefferson City, MO 65109, by emailing Agency at info@mdis4dds.com, or calling Agency at 573-636-8752.

Your Mobile Telephone Number

You represent that you are the account holder for the mobile telephone number(s) that you provide or that you have the account holder’s permission to enter the mobile telephone number(s) that you provide and that you will not initiate messages to the mobile phone of any other person or entity. You agree to maintain accurate, complete, and up-to-date information with Agency regarding your use of the Agency Program, including, without limitation, notifying Agency in writing immediately if you change, or cease being the regular user of, your mobile telephone number. You agree to indemnify Agency in full for all claims, expenses, damages, and costs, including reasonable attorneys’ fees, related to or caused in whole or in part by your failure to notify Agency if you change your telephone number, or cease being the regular user of, including, but not limited to, all claims, expenses, damages, and costs related to or arising under the Telephone Consumer Protection Act, 47 U.S.C. § 227 et seq.

Privacy

Agency’s privacy policy may be accessed at the following link mdis4dds.com/privacy-policy.

Support/Help

To request more information, text HELP to the ten-digit long code from which the text messages are being sent. You may also receive help by providing written notice to Agency at MDIS, 3340 American Avenue, Ste. E, Jefferson City, MO 65109, by emailing Agency at info@mdis4dds.com, or calling Agency at 573-636-8752.

Eligibility

To receive Agency text messages or enroll in the Agency Program, you must be a resident of the United States, eighteen (18) years of age or older, authorized to enroll the mobile phone number in the Agency Program, and authorized to incur any mobile message or data charges incurred by participating. Agency reserves the right to require you to prove the foregoing to participate in the Agency Program.

Changes to These SMS/Text Messaging Terms & Conditions

Agency may revise, modify, or amend these Agency SMS/Text Messaging Terms & Conditions at any time. Any such revision, modification, or amendment shall take effect when it is posted to Agency website. You agree to review these Agency SMS/Text Messaging Terms & Conditions periodically to ensure that you are aware of any changes. Your continued consent to receive Agency text messages will indicate your acceptance of those changes.

Amendment; Termination of Text Messaging

Agency may suspend or terminate your receipt of Agency text messages if Agency believes you are in breach of these Agency SMS/Text Messaging Terms & Conditions. Your receipt of Agency text messages is also subject to termination in the event that your mobile telephone service terminates or lapses. Agency reserves the right to modify or discontinue, temporarily or permanently, all or any part of Agency text messages and the Agency Program, for any reason, with or without notice to you.

Release; No Warranties; Limitation of Liability

By participating in the Agency Program, you agree to release and hold harmless Agency and its representatives, agents, successors, assigns, employees, officers and directors, from any and all liability, for loss, harm, damage, injury, attorneys’ fees, cost or expense whatsoever including without limitation, property damage, personal injury and death that may occur in connection with the Agency, or your use thereof, and for any claims, matters, or disputes based on violation of law or infringement or violation of any rights of any person or entity, including, without limitation, violation of publicity rights, defamation, or invasion of privacy.

THE AGENCY PROGRAM IS PROVIDED AS IS, WHERE IS AND WITH ALL FAULTS AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS, IMPLIED, WRITTEN, ORAL OR ARISING UNDER CUSTOM OR TRADE. Agency DISCLAIMS ALL WARRANTIES, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSES AND NON-INFRINGEMENT.

In no event shall Agency be liable to you, or to any third party, for any losses or damages whatsoever arising out of or resulting from the Agency Program, or your use thereof, regardless of the theory of recovery, including, without limitation, direct, indirect, consequential, incidental or special damages, lost profits, punitive damages, attorney’s fees or any damages arising out of or resulting from a statutory or regulatory violation, negligence, gross negligence, strict liability, tortious conduct, willful misconduct or fraud, breach of contract, or breach of warranty. To the extent this damage waiver is contrary to applicable law, your or any third party’s maximum recovery for any losses or damages whatsoever arising out of or resulting from the Agency Program, or your use thereof, regardless of the theory of recovery, is $10.00.

Arbitration/Class Action Waiver

ALL DISPUTES, MATTERS, OR CLAIMS BETWEEN YOU AND AGENCY ARISING OUT OF OR RELATING IN ANY WAY TO THESE SMS/TEXT MESSAGING TERMS & CONDITIONS, ANY TEXT MESSAGES BETWEEN YOU AND AGENCY OR ANYONE ACTING ON YOUR OR AGENCY’S BEHALF, OR THE AGENCY PROGRAM, REGARDLESS OF THE THEORY OF LIABILITY OR RECOVERY, MUST BE RESOLVED SOLELY BY ARBITRATION CONDUCTED EXPEDITIOUSLY IN ACCORDANCE WITH THE AMERICAN ARBITRATION ASSOCIATION CONSUMER ARBITRATION RULES (“AAA RULES”) BY A SOLE ARBITRATOR SELECTED BY THE PARTIES TO THE DISPUTE FROM THE NATIONAL OR [FILL IN YOUR PREFERRED LOCATION] PANEL OF ARBITRATORS. ALL DISPUTES, MATTERS, OR CLAIMS BETWEEN YOU AND AGENCY INCLUDES, WITHOUT LIMITATION, ANY ACTUAL OR ALLEGED STATUTORY OR REGULATORY VIOLATION, EQUITABLE CLAIM, NEGLIGENCE, GROSS NEGLIGENCE, STRICT LIABILITY, TORTIOUS CONDUCT, WILLFUL MISCONDUCT OR FRAUD, BREACH OF CONTRACT, BREACH OF WARRANTY, AS WELL AS ALL DISPUTES, MATTERS, OR CLAIMS ARISING OUT OF OR RELATING IN ANY WAY TO THE ARBITRATION/CLASS ACTION WAIVER PROVISION OR THE RELEASE; NO WARRANTIES; LIMITATION OF LIABILITY PROVISION.

This agreement to arbitrate is intended to be broadly interpreted, and expressly includes disputes, matters, or claims brought under the Telephone Consumer Protection Act, 47 U.S.C. § 227 et seq., or any other statute, regulation, or legal or equitable theory. THIS PROVISION MUST CONSTRUED IN ACCORDANCE WITH, AND THE ARBITRATION MUST BE GOVERNED BY, THE FEDERAL ARBITRATION ACT (9 U.S.C. § 1 et seq.). ANY JUDGMENT UPON THE DECISION RENDERED BY THE ARBITRATOR MAY BE ENTERED BY ANY COURT HAVING JURISDICTION. UNLESS OTHERWISE REQUIRED BY LAW, THE ARBITRATOR IS PROHIBITED FROM AWARDING DAMAGES IN EXCESS OF THE LIMITATIONS SET FORTH IN THESE SMS/TEXT MESSAGING TERMS & CONDITIONS.

ARBITRATION PROCEEDINGS MAY BE COMMENCED BY EITHER PARTY TO THIS AGREEMENT BY DELIVERING TO THE OTHER PARTY A WRITTEN NOTICE IN ACCORDANCE WITH THE AAA RULES. ANY ARBITRATION HEARING SHALL BE HELD IN JEFFERSON CITY, MO, UNLESS THE PARTIES TO THE DISPUTE AGREE OTHERWISE. ANY JUDGMENT RENDERED BY ARBITRATION SHALL BE FINAL AND BINDING ON THE PARTIES, AND MAY BE ENTERED IN ANY COURT OF COMPETENT JURISDICTION. NOTWITHSTANDING ANY AAA RULES TO THE CONTRARY, THE AWARD OF THE ARBITRATOR MUST BE MADE NO LATER THAN THREE (3) MONTHS FOLLOWING THE DATE ON WHICH THE ARBITRATOR IS APPOINTED, UNLESS THE ISSUE IS THE SUBJECT OF LITIGATION BROUGHT BY A THIRD PARTY AND THE ARBITRATOR DEEMS IT APPROPRIATE TO DEFER ITS AWARD UNTIL THE LITIGATION IS RESOLVED.

The resolution of any claims, matters, or disputes must proceed solely on an individual basis without the right for any claims, matters, or disputes to proceed on a class action or collective basis or on bases involving claims, matters, or disputes brought in a purported representative capacity on behalf of others. The arbitrator’s authority to resolve and make written awards is limited to claims, matters, and disputes between you and Agency alone. Claims, matters, or disputes may not be joined or consolidated unless agreed to in writing by all parties. No arbitration award or decision will have any preclusive effect as to issues, claims, matters, or disputes with anyone who is not a named party to the arbitration.

Attorney Fees

In the event of any claim, matter, or dispute between you and Agency arising out of or relating in any way to these SMS/Text Messaging Terms & Conditions, any text messages between you and Agency or anyone acting on your or Agency’s behalf, or the Agency Program, Agency, if it prevails, must be awarded all costs of bringing or defending the claim, matter, or dispute, including, without limitation, reasonable attorneys’ fees and the ordinary costs and expenses incurred in resolving the claim, matter, or dispute, including, without limitation, all arbitration related fees and expenses.

Applicable Law

The law of the State of Missouri, including its statutes of limitations and without reference to any conflict of laws principles, shall be applied to any claim, matter, or dispute between the parties or when governing, construing, or enforcing these SMS/Text Messaging Terms & Conditions, the Agency Program, or any text messages between you and Agency or anyone acting on your or Agency’s behalf, or any of the rights, duties, or obligations of the parties arising from or relating in any way to the subject matter of these Terms & Conditions.

Contact Us

If you have questions regarding these SMS/Text Messaging Terms & Conditions, you may reach us by calling 573-636-8752, by mail at MDIS, 3340 American Avenue, Ste. E, Jefferson City, MO 65109, or by email at info@mdis4dds.com.