Gulf Coast Dental Membership Club

Thank you for your interest in our Dental Membership Club! This is an exclusive, in-office membership plan being offered to both our patients without dental insurance and patients with dental insurance who would like to consider making a change. What is a dental membership club? Like Sam’s Club or Costco, members pay a membership fee for the ability to purchase a product (or treatment in this case) at a reduced price, which gives patrons an opportunity to enjoy added value in a particular business or office by getting the same products you could find elsewhere but at a more affordable price. With the Dental Membership Club, your membership fee will include 2 cleanings and 1 exam with 1 set of bitewings, 1 periapical x-ray OR a Full mouth series (if due) to be used in a consecutive 12-month period, plus any fluoride treatment should your provider deem it necessary. Thereafter, should you need or want any other treatment during your active membership, you will pay the reduced fee of 80% of our normal fees rather than 100%*.

How is the membership club different than purchasing a dental insurance policy? There are many differences that set us aside from a traditional dental insurance plan. First, you will receive the care that both you and your provider decide is best for your health, not the care that an insurance company dictates. Our country’s health insurance industry is forcing more and more patients to “settle” for a lower quality of care because they are unwilling to provide benefits that are in their client's best interest. Furthermore, many insurance carriers list services that they will cover. Many insurance companies “bump down” or reduce the benefit they will pay for a procedure if there is an alternative treatment available. Leaving the patient to receive out-of-date treatment.

Second, you will only pay for what you use. You won’t be paying insurance premiums “just in case” you might need dental treatment other than preventive care, which will save many patients quite a bit of money each year. Third, there are NO deductibles and NO waiting periods. Many patients take out dental plans only to find out that they must wait 3-6 months or even a year before they are allowed certain procedures covered.

There are many other benefits of the Dental Membership Plan, including:

-NO “pre-existing conditions”
-NO pre-authorizations for any treatment. Your treatment will be covered and you will know exactly what it will cost with NO surprises
-NO benefit maximums; most insurance plans will only pay out a maximum of $1,000 per patient per contract year.
-NO” Exclusions” such as missing tooth clauses, white fillings being paid at the lower benefit of silver fillings, bridges being paid at the lower benefit of a partial denture, etc.
-NO limits on periodontal treatment

How much are the membership fees? Our current, full-price fees for 2 cleanings with fluoride, 1 exam, 1 set of bitewings with 1 periapical x-ray is $454.00 per adult. However, because we are bundling these services into one simple fee, we are reducing that price to $413.00 per adult, and $332.00 per child. So as an adult, you will pay $413.00 for your membership for your preventive care, and should there be any additional need for treatment that may arise, you will receive the benefit of getting those services at the reduced rate of 80% of our normal fees.

Good for 1 YEAR from purchase date. This membership can be renewed yearly.

Extended Membership Fees are:

Adult	$413.
Adult & Spouse	$792.
One Child	$332.
Each additional child	$264.

We are very excited to offer this opportunity to our patients and new patients. We hope you will take advantage of this chance to save on your dental health needs.

Patient Signature:

Date:

Doctor and/or Manager Signature:

Dental Membership Plan