AMERICA*S DENTAL ASSOCIATES

AMERICA'S PRE-PAID DENTAL PLAN

Exclusively Offered by Dr. Rob Rainey

NEW PATIENT

INITIAL FEE CALCULATOR

America's Dental Associates billing dates are January 1st and July 1st of each year. 

                  In order to get on the CORRCT BILLING CYCLE, select your FEE for the remaining                         months from the FIRST of NEXT Month until either January 1st or July 1st.

Enter the appropriate # of months remaining until either January 1st or July 1st . . . . . . . . . . . . . . . . . . . . . . . . . # Months ______

 Enter the Fee for 1 Month and Multiply it times the number of Months entered for TOTAL FEES . . . Fee Amount $_________

                                                                                                                                                       TOTAL INITIAL FEES  $______________      

FEE SCHEDULE

                                                                                      PRO-RATA FEE                                  SEMI-ANNAL FEES

              COVERAGE                       1 Mo          2 Mo          3 Mo          4 Mo          5 MO               6 Months_____

                Individual                        $13.00        $26.00       $39.00       $52.00        $  65.00               $  78.00

                Individual + 1                  $16.50        $33.00       $49.50       $66.00        $  82.50               $  99.00

                Family (3 or more)          $24.00        $48.00       $72.00       $96.00        $120.00               $144.00

NOTE: 

Once the "TOTAL INITIAL FEE" has been entered write it down and CLICK ON CHECKOUT in the menu bar.