Member Participation Agreement
As a member of NCE GapAfford Plus, you are a participant in a Discount Medical Program (Plan) provided by Access One Consumer Health, Inc. Below are the terms and conditions of your membership in the Access One Consumer Health discount medical plan. 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 Plus or Access One Consumer Health is notified of your cancellation.
The Charge and mode of payment for participation in the plan is on your enrollment form. If you need to change your payment mode, please contact the member services number on your identification card.
DISCLOSURES:
- This plan is a discount plan NOT a health insurance policy.
- This plan provides discounts at certain health care providers for medical services.
- This plan does not make payments directly to the providers of medical services.
- The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount medical plan organization.
- The DMPO does make available an up-to-date list of all program providers which includes their name, city & state, and medical specialty prior to purchase, upon request.
- That the range of discounts for medical services provided under the plan will vary depending on the type of provider and the medical services received.
- The corporate name and the location of the licensed discount medical plan organization is: Access One Consumer Health, Inc., 84 Villa Road, Greenville, SC 29615; 800-896-1962; www.accessonedmpo.com.
You may find a list of participating providers at: www.ncegapaffordplus.com or you may call: 877-271-6559. You will be able to access DMP discounts at participating providers of each participating network.
This DMP includes discounts for dental, vision, prescriptions, hearing, chiropractors, speech therapy, and prepaid labs. Depending on your plan selection you may not have access to all of these benefits. The included Benefit Descriptions: Dental discounts between 15% to 50% per visit on most dental procedures; Vision discounts between 10% to 50% on vision care; Prescription discounts 15-50% at local pharmacies, up to 80% on brand-name mail-order; Hearing discounts up to 40%; Chiropractic discounts up to 30% at participating locations. The minimum discount for any service provided under the Plan is 5% and may go to as much as 50%. The Benefit Descriptions becomes part of this Membership Agreement.
You will be billed at the time of service by the participating provider who will apply the applicable discounts to that bill. In no instance can Access One Consumer Health make payments directly to the provider on your behalf.
Your participation in the plan will continue as stated on your enrollment form, "monthly", "semi-annually" or "yearly", upon payment of your dues and shall cease upon (i) your failure to make the payment; or (ii) notification in writing (USPS, email or facsimile) of you desire to cancel.
You have the right to cancel participation in the program at any time. If you do so within 30 days after the effective date of enrollment in the plan, you will receive a full refund of all fees and or dues paid to participate in this plan less the non-refundable enrollment fee. 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 months you have not used. 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.
Access One Consumer Health may terminate your participation in the plan if you fail to make your membership payment when due.
This plan includes you or you and all members of your household (you, your spouse, and legal dependents). You are not required to list your dependents to participate in the plan. You may add dependents or additional members of your household by calling Access One Consumer Health at 800-896-1962.
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, Inc. 84 Villa Rd. Greenville, SC 29615. The complaint will be addressed, and you will receive a response no later than the 30th day after we receive the complaint. If you are dissatisfied with the result, you may contact your state insurance department.
This Member Participation Agreement includes an arbitration provision, a waiver of jury trial, and a prohibition on participation in class actions. These provisions can be found in the Addendum on our website at accessonedmpo.com/member-agreement-addendum/ and are incorporated herein by reference and made a part of this Member Participation Agreement to the same extent and with the same force as fully set forth herein.
This Agreement and its Benefit Descriptions represent the entire agreement between you and Access One Consumer Health, Inc. and supersede all other prior representations, statements, or written agreements between you and Access One Consumer Health.
ARKANSAS RESIDENTS You may cancel your membership in the discount medical plan organization within the first thirty (30) days from receipt of your ID card and receive a full refund of all fees or dues paid. ILLINOIS RESIDENTS If you are not satisfied with your resolution of your complaint, you may contact Illinois Department of Insurance. LOUISIANA The mode of payment of any processing fee and periodic charge were agreed upon when purchasing the plan. You may contact member services to change your mode of payment. The member services number can be found on your identification card. If a member cancels his membership in the discount medical plan organization within the first thirty days after the date of receipt of the written document for a discount medical plan, the member shall receive a reimbursement of all periodic charges and the amount of any one-time processing fee that exceeds thirty dollars upon return of the discount medical plan card to the discount medical plan organization. MARYLAND RESIDENTS "Discounts for hospital services, if any, are not applicable in Maryland." MASSACHUSETTS RESIDENTS The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act of Massachusetts M.G.L. c. 111M and 956 CMR 5.00. NEBRASKA RESIDENTS If you have cancelled at any time after the 30-day period, and you have pre-paid any membership fees, the prepayment will be refunded on a pro-rata basis for months you have not used. NEW YORK RESIDENTS "Nurseline" not available in New York. SOUTH CAROLINA RESIDENTS You may cancel your membership in the discount medical plan organization within the first thirty (30) days from receipt of your ID card and receive a full refund on any fees or dues paid, less the one time processing fee. TENNESSEE RESIDENTS You may cancel your membership in the discount medical plan organization within the first thirty (30) days from receipt of your ID card and receive a full refund of all fees or dues paid. TEXAS RESIDENTS Access One Consumer Health will cease collecting membership fees in a reasonable amount of time, but no later than (30) days after receiving a valid cancellation notice. If you are not satisfied with your resolution of your complaint, you may contact your State Department of Insurance. UTAH RESIDENTS These programs are not covered by the Utah Health Insurance Guarantee Act. WEST VIRGINIA RESIDENTS If after receiving our response and you are not satisfied with the resolution you may write of call: West Virginia Insurance Commissioner
This plan is not available in Alaska, Utah, Montana, Rhode Island, Washington, and Vermont.
GAPMPA-P/0211