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Health Care Connect
All members of HealthCare Connect can now participate in a voluntary dental plan offered through American Dental Plan. ADP, Arizona's oldest individual dental benefit plan, can provide you and your family complete dental services from over 450 participating dentists in Arizona.  As a member, every person in your family will receive their initial exam and first 4 x-rays at no charge! Additional dental services including cleanings, fillings, crowns, bridges, etc. are available at 20-40% savings from usual and customary fees. This dental plan even includes specialists, orthodontics and implants.

When you join American Dental Plan, there are no waiting periods, no claim forms, and no deductibles.  All benefits are available immediately!  Family members, up to age 19, living at home, can be covered under the family plan.  And regardless of your employment, age, income levels or future enrollment with HealthCare Connect, your family can continue to enjoy the many benefits offered by American Dental Plan.

  Yearly fees 
    One Person.................................................................    $54
    Two Persons...............................................................    $74
    Entire Family...............................................................    $94
      New members include a one-time enrollment fee      $10     

It's easy to enroll!  Just complete the form below, make sure you list all dependents, select the level of membership, choose a dentist and include payment information.  Then click the "submit" button. 

You may also print the form, complete the information and mail to: 
             American Dental Plan
            1645 E. Bethany Home Rd.
             Phoenix, AZ  85016

Or, you may print and fax the enrollment form to (602) 266-0607. 

Enrollment is also accepted by phone by calling (602) 265-6677 between the hours of 9am and 4pm Monday -Thursday or until 3pm on Friday.

We accept checks, money orders, Visa, Mastercard and Discover cards.  Cash payments must be made in person at our Administrative Office located in Phoenix.  Once we receive your application, and payment, it will be processed and ID cards will be mailed directly to your home.  You will then receive a renewal notice when it is time to renew your dental plan.

Additional information concerning American Dental Plan can be obtained by selecting the appropriate category listed on the left side margin.  Feel free also to visit our FAQ section.



(* Required Fields)
Last Name*
First Name* Middle Initial
Email*
Street*
Apt #
City* State*
Zip*
Daytime Phone Date of Birth
Spouse
Name of Employer
Dental Center Number*
(please select from links above)		 Code
   
  Dependents' Name(s)   Birthdates
   
   
   
   
   
   

I agree to all terms of membership*

Select Plan Type (Annual Membership Dues*):


*New memberships include a one-time $10 enrollment fee.

MasterCard VISA Discover

Card Number* Expiration Date*
3 or 4 digital security code on back of credit card *
Printed name as it appears on the card*

Authorization signature _______________________________________
Date