TERMS & CONDITIONS

1. Member is defined as primary member, spouse, and all legal dependents. All legal dependents are automatically enrolled and no additional enrollment is required.

2. At any time, a participating professional may be eliminated from the respective network in which they are associated.

3. Companies providing benefits and discounts in this program are not a licensed insurer, health maintenance organization, or other underwriter of health care services. No portion of any provider’s fees will be reimbursed or otherwise paid.

4. The discounts contained herein may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices from participating providers and subject to change without notice. From time to time, certain providers may offer products and/ or services to the general public at prices lower than the discounted prices available through the program. In such event, members will be charged the lowest
price.

5. Providers are subject to change without notice and programs may vary in some states. This is a discount membership program only, not insurance, and may be discounted or modified at anytime.

6. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased.

7. This program is a referral and discount plan and does not warrant professional services, nor is it responsible for the quality of care received. This program makes no warranties express or implied concerning services or care provided.

8. Companies providing benefits and discounts in this program are not licensed to provide and do not provide medical services or items to individuals. Providers contracted by each network associated with this program are solely responsible for the professional advice and treatment rendered to members and each company disclaims any liability with respect to
such matters.

9. 30- day Money Back Guarantee: If you cancel for any reason within 30 days, you will receive a full refund. Non-refundable one-time fees will be disclosed at the time of application.

 

 

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Primary Member Information
First Name: Last Name:
Date of Birth: Gender:
 
Home Phone : Work Phone :
 
E-mail: IMR #
 
Address: City: State:
 
Zip Code: Country:
 
Beneficiary:
First Name: Last Name:
DEPENDANT INFORMATION: (if applicable)
 
First Dependant  
   
First Name: Last Name:
 
Relationship: Date of Birth:
 
 
Second Dependant  
   
First Name: Last Name:
 
 
Relationship: Date of Birth:
 
 
 
Third Dependant  
   
First Name: Last Name:
 
 
Relationship: Date of Birth:
 
Health Plans
 
Select Plan : Plan Name
 
 

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