Plan Design

American Dental Plan, founded in 1978, is Arizona's oldest voluntary dental benefit plan. It is based upon the reduced fee concept which, we believe, is the most cost effective method of obtaining dental benefits. This means that rather than paying regular monthly premiums to an insurance company, (and hoping that the benefits you receive will equal or exceed the amount of premiums you have paid), you purchase a membership to a network of dentists and pay a reduced fee only for the services you actually receive. The membership fee you pay to join the Plan gives you access to a proprietary dental provider network that offers dramatic savings on all your dental care needs.

In many instances your first visit to the dentist saves you more than the price of your yearly membership fee.

Indemnity: The oldest form of traditional insurance and very few plans still exist today. It is socialistic in nature; "premiums from the many pay for the claims of the few."  Indemnity insurance is available only for groups. This is because the loss ratios would be too extreme to issue on an individual basis. People would purchase insurance for a specific claim and insurance companies would go broke paying those claims because they could not collect enough money in premiums before a claim is submitted. .

This is the most expensive form of dental insurance for a company to offer since the employee can choose any dentist and the dentist submits their usual and customary fees to the insurance company for reimbursement. There are no limits to how much the dentist can charge for each dental procedure. Using this form of insurance, there are waiting periods, pre-existing exclusions, deductibles and yearly benefit limits to coverage.

Most all dentists will accept indemnity insurance plans because they are able to charge full price!

Keep in mind. Insurance was designed to offer financial assistance in paying bills. It is not benevolent in nature and the insurance company looks to make a profit. The insurance company will always collect more money in premiums then they will pay in claims. If their profit is decreased due to higher claims submitted from the insured, then premiums are increased and/or benefits reduced.

PPO Plans
As a method of controlling reimbursement claims to dental offices, a PPO dental plan creates upper limits to the amount of reimbursement paid to a dentist for each dental procedure. So regardless of what the dentist usually charges for a procedure, the PPO has determined the maximum amount of reimbursement for each dental procedure. Dentists who participate in PPO plans must agree to accept the limits of reimbursement in exchange for a patient being sent to their office for dental treatment. PPO plans are designed mainly for group coverage.

Prepaid or HMO Dental Plans : Prepaid dental plans were first introduced in Arizona in the mid 1970's. Again, these plans were designed for group coverage. This type of dental plan allows the dentist to receive a portion of your monthly premium, called capitation, to help pay for routine services such as cleanings, examinations, x-rays, fillings, fluoride and extractions. Fees for other dental services are reduced and paid by the patient at time of service. In order for a dentist to participate in the plan, he/she must agree to accept the capitation as payment for the free services and the reduced fees for other dental services.

However, experience has shown that dentists are unable to provide these free services for the capitation received. Treatment is sometimes delayed in order for the dentist to receive additional capitation. Delayed treatment sometimes results in more extensive dental work being performed; such as waiting to fill a cavity can result in a root canal and crown. Popularity of prepaid plans have dramatically decreased due to the inability of the employee to schedule an appointment with the dental office.  Furthermore, dentists were not receving their capitation checks from the insurance companies.  Monthly costs for coverage range between $27 to $45 per month.

Direct Reimbursement Plans:  Some larger companies have started to create their own dental benefit package by creating a "self insurance" plan.  With the help of an actuary, and using a reinsurance policy, companies have created the ability to reimburse the employee for certain dental procedures, limited only to the design of the plan that was created by the employer.  This model allows the employee to choose any dentist and have more control over the type of dental services provided.  But with choice also comes cost.  DR plans are ideal if coupled with a Discount Plan to allow greater savings and choice.

Discount Dental Plans: As a way to keep costs low, reduced fee (discount) plans also took shape in the late 1970's. Since there is no reimbursement from any third party or capitation paid to the dentist, the cost of administration is greatly reduced .  The dentist agrees to reduce his/her fee for dental services in exchange for a steady stream of cash paying patients. The dentist's overhead is greatly reduced since there are no advertising fees, no added paperwork for submitting claims, no receivables, and no restrictions or limits to coverage. Payment for dental services is immediate and the dentist has more time to treat patients.

Unlike the indemnity, PPO, prepaid and DR plans, discount dental plans are not regulated by the Department of Insurance or any other governmental agency. Therefore, any person wishing to purchase a discount dental plan should be careful and understand exactly what they are buying. (Some plans are actually multi-level marketing organizations being sold by individuals with limited knowledge of dentistry. BUYERS BEWARE!)

American Dental Plan: American Dental Plan is classified as a voluntary "discount" dental benefit plan. Founded in 1978, we are Arizona's oldest individual and voluntary dental plan with tens of thousands of members. There are over 650 independent participating dentists throughout Arizona, including specialty dentists such as oral surgeons, endodontists, periodontists, prosthodontists and orthodontists.

Memberships are priced as follows:

Individual	$ 59 per year
2 Persons	$ 79 per year
Entire Family	$ 99 per year

For only an additional $25 per year, you can upgrade your membership to the "Plus" Plan which provides the same the dental benefits described above and adds hospital, medical, pharmacy, optical and chiropractic benefits.

American Dental Plan is the best value available for groups and individuals looking for cost effective alternatives to traditional indemnity and prepaid dental plans.

Companies can also offer American Dental Plan as a "second choice" for their employees or to fill in gaps with their existing coverage.

To receive additional information about American Dental Plan, return to the main menu and select Member Benefits. Or, you may obtain a printed brochure by contacting the American Dental Plan administrative office at (602) 265-6677, toll free in Arizona (800) 224-8810 and speak with a Customer Service Representative Monday-Thursday, 9:00 am until 4:00 pm and until 3:00 pm on Fridays (MST).