Heard the saying: “If you’re a hammer, everything looks like a nail”?
For many vendors, every dental membership they offer is a discount plan that must be administered by a Discount Medical Plan Organization. Plan Forward is different. Here, we’ll explain why only offering a discount plan administered through a DMPO is an overly simplified, black-and-white view of the world.
In reality, in the world of dental membership & discount plans, there are nuanced regulatory requirements. It is not one size fits all, and it’s important to understand the different allowable structures as well as the states’ regulatory intent in order to know the boundaries. Please note this is not legal advice.
The key question that state regulators address with regulation is: Are membership or discount plans a form of insurance? If they are, then the practice or group must comply with state insurance laws. If they are not, these plans are generally treated as a contractual relationship governed by applicable state contract law and consumer protection statutes.
States have taken 2 main approaches:
1. Direct Primary Care (DPC)
In this model, patients pay the practice a periodic fee directly in exchange for access to care or discounted services. The relationship is defined by a contract between the patient and the provider.
Over 20 states (ADA list here) have enacted DPC-specific safe harbor laws that explicitly state these agreements are not insurance, provided certain conditions are met (e.g., clear disclosures, no risk-sharing, etc.). In states without specific statutes, the state’s applicable contract law and consumer protection statutes generally apply.
2. Discount Medical Plan Organization (DMPO)
Starting with Florida in 2004, some states created a distinct regulatory category for discount plans. These laws require the entity administering the plan (the DMPO) to register or obtain a license with the state’s insurance department. Requirements typically include registration or licensure, mandatory disclosures, complaint procedures, financial requirements, and network transparency.
In this model, the state insurance department has explicit enforcement authority over the DPMO including fines, license revocation, and cease-and-desist orders. Today, roughly 24 states require some form of DMPO licensure or registration.
The reality is messy.
While this blog lays out two regulatory models, many states have both DPC & DMPO laws, some have neither, and some have only one. Furthermore, some DMPO statutes explicitly exempt dental practices that offer discounts to their own patients. Here are just two examples:
– Florida (Section 636.204(6)): “This part does not require a provider who provides discounts to his or her own patients to obtain and maintain a license as a discount plan organization.”
– South Carolina (Section 37-17-20(C)): “This section does not require a provider who provides discounts to his or her own patients to obtain and maintain a license pursuant to this chapter as a discount medical plan organization. “
Why does this matter?
Each state is different & has different requirements. Many vendors will have you believe that everything fits neatly into one regulatory regime requiring a DMPO. It need not.
Plan Forward’s approach is unique – we’ve built a platform that allows for all of the nuance. If you’re a group with practices in DPC & DMPO states, we assist your practice in managing compliance within both regulatory regimes, on a single platform. Membership/discount plans are not one-size-fits-all; providers prefer different structures, and we can accommodate each practice’s individual preferences.
What truly sets us apart is how we make it simple for dental practices and groups to launch and manage high-performing membership plans across multiple states, without getting buried in regulatory complexity.
Plan Forward frees you to focus on growth, patient loyalty, and practice profitability.
The information provided here is for educational purposes only and does not constitute legal advice. For questions about Plan Forward’s compliance infrastructure, contact us at care@planforward.io or (833) 752-7526.
