LA Dental Discount Plan Membership Agreement
Are you avoiding the dentist because you don’t have dental insurance?
Wouldn’t it be nice to know that you can take care of your family’s dental care for a reasonable cost?
That’s why we have created the LA Dental discount program. We know that there are many people who don’t have dental insurance and are afraid of the costs of dental care. If you join our discount plan you automatically receive 20% off of your dental treatment. Plus, you get two dental exams and cleanings every year (This program is for patients with no dental insurance).
Here’s how it works:
Your membership fee includes 2 cleanings, exams and x-rays every year. Prevention is the best way to keep your teeth healthy and by preventing problems early on, you will save a lot of time, pain and money.
That’s it!! There are no waiting periods and your previous dental history does not matter. We are not an insurance company, so we want to keep it as simple as possible and provide you with an affordable way to take care of your family’s dental needs.
LA Dental In House Plan Membership Agreement and Description of Services and Disclosure Form
PLEASE READ THE FOLLOWING AGREEMENT SO THERE IS NO CONFUSION AS TO WHAT YOUR ARE PURCHASING AND WHAT YOU CAN EXPECT FROM US.
1. Description of the Plan – This plan is not dental insurance. This is a discount plan. We are providing it only to our patients who don’t have dental insurance. When you become a member you are entitled to receive 20% off our regular fees for services that are not already on promotion or discount.
2. Location of Service – The only location you may use this plan is at Los Angeles Dental Clinic. 2500 Wilshire Blvd. Suite 1100. This plan will not apply at any other dental offices.
3. Discounted Fees – The Dental Care services provided at Los Angeles Dental are discounted by 20%. Any services not available at this location or if you need the services of a specialist are not discounted.
4. Exclusions and Limitations – Dental Care services must me received at Los Angeles Dental Clinic. Dental Care Services must be performed during the member’s effective membership date. If services are started prior to the membership effective date or after the termination of the membership, they will not qualify for the discounted rates. Any specials advertised by LA Dental will not be subject to the plan. Only services under our regular fee schedule will be discounted. Invisalign, veneers, Implants, Bone Grafts, abutments and implant crowns are not included.
5. Membership Fees – Fees are due at the beginning of the membership period. The membership period is for 12 consecutive months and is renewable after that.
6. Effective Date of Coverage – After submitting the paperwork and payment of the membership fee, you are considered a member and eligible for discounts immediately.
7. liability of member for payment – Members are liable for payment at the time of treatment. This Plan does not make any payments and it is just a discount plan.
8. Emergency Services – Emergency services will be discounted for members at Los Angeles Dental Clinic during normal business hours. Any after-hour emergency will not be considered as part of the plan. If you go to a different dentist for an emergency or any other service, Los Angeles Dental will not be responsible for the costs incurred and will not make any payments on your behalf.
9. Adding Dependents – A member and any eligible dependents are equally entitled to all discounts for the term for which the subscriber has paid. Subscribers may add up to three family members to the plan by notifying us in writing and making a prorated payment for the remainder of the membership term.
10. Renewal Provisions – At the conclusion of the initial and subsequent membership terms, membership will be renewed automatically unless you notify us in writing or by e-mail.
11. Cancellation or non-renewal – An enrollment or a subscription may be cancelled up to 30 (thirty) days from effective date. Any services performed prior to the cancellation will be deducted from the refunded amount to the member.