Welcome to

The American Dental Plan

A CompBenefits Company

"Enrolling in the American Dental Plan"

Click at the bottom of this page or from home page to print the application. (Also referred to as enrollment form.)  Fill out the application according to the directions listed by the application.

The enrollment fee is $35.00 per application, regardless of how many family members are on the application. The enrollment fee is payable only once, this is not a yearly fee.

Make your check payable to CompBenefits Corporation. Your check amount should equal your premium amount listed on the premium page plus the one time enrollment fee of $35.00.

 Your monthly bank draft will be the monthly premium plus the $1.00 administrative fee. You may pay for the entire year if you prefer. If paying yearly, you can use a check, Visa, MasterCard or money order. The amount should equal your yearly premium plus the $35.00 enrollment fee. ADP does not charge a monthly charge on your credit cards, only the full yearly amount. In addition, there is no monthly billing for monthly payments, only the automatic bank draft. The dollar administrative fee is eliminated with yearly paid premiums.

"Monthly Bank draft" - Please include a voided check or a request for the voided check will be made and this will delay your enrollment.

*The application should reach the Home Office by the 10th of the current month to have an effective date for the 1st of the following month.

Mail application to:

Thank you for enrolling in The American Dental Plan. We feel confident you will be pleased with the services you are about to receive from the Dentists on our preferred provider list. Your membership card will arrive the first few days of your effective month. A few days later you will receive information on your vision and pharmaceutical benefits. A toll free number will be available for your nearest vision locations. You will also be instructed on how to utilize the pharmaceutical benefits.

Please feel free to send an e-mail if you have questions not answered on these pages. You may want to read the page of "Frequently asked questions" first !

saracazin@floridadentalinsurance.com

Please direct any questions to (813) 909-7645 - (813) 909-SMILE

You may also call the toll free number of American Dental Plan's Home Office:

Member Services: 1- 800 - 342 - 5209

Click to print enrollment form