Dela Rama Dental In House Membership Program

Adult Membership Plan

Includes:

2 cleanings, 2 periodic exams, 2 sets of routine x-rays/year, ($700+ value)

1 emergency exam with set of emergency x-rays/year, ($350+ additional value)

• Palliative treatment (the treatment necessary to take the patient out of pain) is a separate fee. (Can range from $150-300 depending on treatment)
  
• Can be used for an In Person/Virtual Doctor Consult

2 fluoride treatments per year ($120+ additional value)

$250 off all orthodontic treatments (metal braces or Invisalign treatment)

10% discount off all restorative treatments (non orthodontic)

**Valid only at South San Francisco office**

Payment Options

Annual Plan Adults (age 18+)	Annual Plan Children (17 & under)
$575/year	$500/year

 

 Periodontal Patients:

Adult plan plus 2 extra cleanings (total of 4 cleanings/year)

$1100/year

 

Deep Cleaning Patients:*

Adult plan plus Full Mouth Scaling & Root Planing 

(aka SCRP or Deep Cleaning)

$1850/year

*Deep cleaning patients are recommended to change to periodontal plan after year 1

Please read the following:

• This is NOT dental insurance.
• This an in-house dental membership plan that is ONLY good at Dela Rama Dental Care (South San Francisco Location). It is meant to be an alternative to purchasing traditional dental insurance.
• The ADULT PLAN can be a standalone plan, or can be used as a supplement for additional cleanings if that patient's insurance plan only allows for 2 cleanings per year.
• Valid with health savings accounts, flex spending accounts, and health reimbursement accounts.
• Annual membership fee is due immediately, and is non recurring. You must reapply annually in person at our office or online.
• Please note a 3.5% surcharge applies to all credit card payments.
• Plans may be purchased with a financing programs such as Cherry or CareCredit with a 10% surcharge.
  
• In the event of a price increase, membership fees may be "grandfathered" for one additional year as long as the membership remains continuous and in good standing.
  
• Annual membership fee is nonrefundable after the first cleaning has been performed.
• Plans may be cancelled at any time in person at our office, over the phone, or emailing our office. Benefits will be cancelled IMMEDIATELY. Unused portions of the membership plan will not be refunded.
• Once a membership cycle is cancelled, patients must re-enroll as new members at the current price.
• Plans may be upgraded at any time without incurring any setup fees.
• Plan downgrades must wait until the next enrollment cycle to take effect.
• All benefits (exams, x-rays, cleanings, fluoride) must occur within 365 days of enrollment and cannot be carried over to the next year.
• Additional treatments (restorative work, extractions, root canals, etc) must be PAID IN FULL the day of treatment to qualify for the discount and keep the plan active.
  
• All fees will be based on the treating doctor's fee schedule and not any dental plan's fees.
• Program is not transferrable or sharable to another party or uncovered family member.
• Does not cover any portion of a specialist referral fee.
• Not applicable to hospitalization or hospital charges of any kind.
• Will not apply to dental care for injuries covered under worker's compensation.
• Will not apply to dental care for which, in the sole opinion of the treating dentist, lies outside the realm of their capability.
• If member uses their membership for a discount on braces or Invisalign, but cancels their plan before their balance is paid in full, that discount will be voided, and the remaining balance will due immediately.
• Benefit 10% discount applies to General Dentistry, Hygiene & Speciality Services performed in our office only.
• All orthodontics, including appliances, retainers & partial ortho treatments not eligible for the 10% discount.
• We reserve the right to change program terms at any time. We will notify you if your specific plan is modified.