GapAfford Supplemental Discount Medical Program

Disclosures

Disclosures

Membership Participation Agreement

As a member of NCE GapAfford, you are a participant in a Discount Medical Plan Organization provided by Access One Consumer Health Below are the terms and conditions of your participation. This agreement is between you and Access One Consumer Health.

The effective date of your enrollment is shown on the Member ID and shall continue from month to month until NCE GapAfford or Access One Consumer Health is notified of your cancellation.

DISCLOSURES:

•    The plan is not insurance;

•     The plan provides discounts at certain healthcare providers for medical services;

•     The plan does not make payments directly to the providers of medical services;

•     The  plan  member  is  obligated  to  pay  for  all healthcare services but will receive a discount from healthcare providers who have contracted with the discount plan organization;

•     The name and address of the licensed discount medical plan organization: Access One Consumer Health,  84  Villa  Road,  Greenville,  SC  29615;

800-896-1962; www.AccessOnedmpo.com. You may find a list of participating providers at: www. ChoiceValueSavings.com   or you may call: 877-

376-5831. You will be able to apply plan discounts to all participating providers of each participating network.

You will receive discounts at participating medical equipment & supplies, and rehabilitation services ranging from 5% to 40%, and participating pharmacies provide discounts of 5% to 40% for pet medications.

The discounts for participating dentists range from 15-

50% off standard billed charges per visit.

 

The Member Agreement (DACMPA-P/0211), Member Guide (DACGUIDE-P/0612x) and Member ID Card (DACID-P/0211) represent the entire Agreement between you and NCE GapAfford and Access One Consumer Health

You will be billed at the time services are provided by the participating provider who will apply the applicable discounts to that bill. In no instance can NCE GapAfford  or Access One Consumer Health make payments directly to a provider on your behalf.

Your participation in the plan will continue from month to month upon payment of your monthly dues and

 

shall cease upon (i) your failure to make the monthly payment; or (ii) notification in writing (USPS, email or facsimile) of your desire to cancel.

You may cancel your membership in the discount medical plan organization within thirty (30) days after the effective date of your participation or receipt of your ID card, whichever is later, and receive a full refund less a minimal processing fee if applicable. After the first thirty (30) days, you may cancel participation at any time and if you have pre-paid any membership fees, the prepayment will be refunded on a pro-rata basis for the unused months. Notification must be received at least five (5) business days in advance of the next billing cycle for you not to be charged for that billing cycle.

Participation in the program may be terminated if you fail to make a payment when due.

This plan includes you and your dependent children at no charge. You are not required to list your dependents to participate in the plan.

If you have a complaint regarding the plan you may go to: www.AccessOnedmpo.com or call 800-896-1962. You may also write to Access One Consumer Health

84 Villa Rd. Greenville, SC 29615.  The complaint will be addressed and you will receive a response within

15 days.

 

THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act. This is not a Medicare prescription drug plan.

This Agreement and its Benefit Descriptions represent the entire agreement between you, Dentachoice and Access  One  Consumer  Health  and  supersedes  all other prior representations, statements, or written agreements between you and Dentachoice or Access One  Consumer  Health.  Neither  Dentachoice  nor Access One Consumer Health has liability for providing or guaranteeing service or any liability for the quality of services rendered.

Note: Keep a copy of the Member Agreement for your records.

NCE GapAfford Plus
1000 N West Street Suite 1200
Wilmington Delaware, 19801
PHONE: 888-886-1796

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