About the Program
The Jones Foundation and Delta Dental of Kansas partner to cover most approved dental services through one of three Delta Dental Premier® Programs. Covered services may include cleanings, X-rays, exams, routine dental work, and oral surgery.
If you are uninsured or need assistance with an exam or cleaning, please apply before receiving services.
For dental work or oral surgery, please apply before treatment whenever possible and include a copy of your treatment plan. Assistance may be available whether or not you have dental insurance.
Program Rules
- The Jones Foundation reviews all applications for eligibility. The Board of Trustees has sole discretion to determine whether assistance will be awarded and in what amount.
- If an applicant has insurance, treatment providers must be in-network.
- Payment authorizations are limited to a specific service or period of up to one year, unless otherwise specified.
- Some restrictions do apply, and not all services are covered.
Eligibility
To be eligible for this program, applicants must:
Be under age 21 for general dental services or under age 19 for braces / orthodontics.
Be a US citizen or non-US citizen with Lawful Immigration Status of Permanent Resident.
Have lived continuously in Coffey, Lyon, or Osage County, Kansas for at least one year immediately before applying.
Additional Eligibility Requirements for Braces/Orthodontics
In addition to satisfying the eligibility requirements above, applicants must also meet the following qualifications unique to orthodontic services:
- require braces for medical reasons (as diagnosed by a state board licensed orthodontist at an orthodontic consultation)
- be referred to Jones Foundation by orthodontist
- not be wearing braces, currently; nor ever have received braces from the Jones Foundation
Required Documents
Along with your application, you’ll need to submit the following documents:
- Most recent complete Federal Tax Return. If you file a separate business return, you must also provide a copy. If married and file separately, both are required. If you live together and both individuals file returns, both are required.
- Most recent paystubs (must include year-to-date earnings).
- Proof of all additional monthly income for previous year.
- Copies of medical and dental insurance cards.
- Copy of state issued birth certificate or legal immigration status documents for each child for whom you are requesting assistance. This is not necessary if you have previously provided a copy.
- Any pertinent medical/dental information that includes important information to support your specific request. This includes any bills received, insurance explanation of benefits, recommended treatment or treatment plan, etc.
- If you have applied for financial assistance from other organizations or patient assistance programs, include this information along with any amounts requested/received.
For your convenience and security purposes we request that you use our secure Dropbox link to upload all required supporting documents. Non-sensitive documents may be delivered to the office or emailed to jonesfdn@gmail.com.
Need help finding documents? See our resources page for helpful links to obtain your personal records or tax information.
Apply Now
Click the button below. You’ll answer a few questions to determine your eligibility for assistance. If you qualify, you’ll be able to submit your application online.
Apply Online Now