MEMBER TERMS AND CONDITIONS – SureHealth Plus Plans

This Agreement is between you, our valued Member (Member[s]), and Consumer Health Choice Association (CHCA), the sponsor of your SureHealth Plus Plan. This Agreement shall be effective on the date your Initial Monthly Payment processes and sets forth the terms and conditions of your (CHCA) membership.

Plan Description: SureHealth is a limited medical insurance product available to individuals from age 18 to age 69 with coverage terminating at age 70.

Fulfillment – Your membership handbook and identification cards will arrive in the same package via U.S. Mail within 3-5 business days. If you have access to the internet, you may view or print your membership handbook which includes plan benefit descriptions by accessing the Member Resource Library page at

Effective Date of Policy: If you applied for a SureHealth Plus plan between the 1st and the 15th of the month, you may select the Initial Effective Date for your plan to be either the 1st or 15th of the following month. If you applied between the 16th and the last day of the month, you may select the Initial Effective Date for your plan to be the 15th of the following month or the 1st of the next following month.

Monthly Payments: As authorized at the time of your application, your Monthly Payments shall be paid through an automatic draft of a checking or savings account by an ACH transaction or through an automatic debit transaction to a credit card. By agreeing to make your monthly payment through either ACH transaction or automatic debit transaction to your credit card, you waive the right to any future notice of the transfer of funds via either an ACH transaction or automatic debit to your credit card. The bank draft or debit shall occur on the same date of each month as your Initial Monthly Payment and shall be referred to herein as your monthly due date. As a member, you agree that inquiries or challenges to ACH or Credit Card charges shall be limited to two (2) monthly payments and waive all rights to inquire into or challenge any and all other monthly payments. Your authority shall remain in affect until CHCA receives a signed, written request from you to cancel your membership and plan benefits. If any payment is dishonored (with or without cause, intentionally or inadvertently), CHCA assumes no liability whatsoever, even if the result of the dishonored payment is a termination of your CHCA membership and SureHealth Plus Plan coverage.

Exception: If your Initial Monthly Payment occurred on the 29th, 30th, or 31st of a month, your monthly due date shall be the 28th of every month thereafter.

Grace Period: Unless you have sent a prior written request for cancellation, you are entitled to a 31-day grace period if any Monthly Payment is dishonored or remains unpaid for any reason. Dishonored payments must be paid within 31 days of monthly due date to prevent a lapse in benefit coverage.

Reinstatement Period: Unless you have sent a prior written request for cancellation, you are entitled to a 45-Day Reinstatement Period, which begins on the payment due date. If you fail to make a payment within the Grace Period, your coverage shall lapse. You shall have 14 days from the end of your Grace Period in which to make the payment and complete any required application for reinstatement. If approved, we shall notify you of the effective date of reinstatement and benefits shall only be reinstated for coverage of any injury that occurs after the date of reinstatement and for coverage of any illness occurring 30 days or more after the date of reinstatement.

Plan Changes: All plan changes shall be requested in writing and sent to us via mail (excluding e-mail), or Members may complete a Plan Change Form, which can be requested by calling 800-337-1421. Written requests for plan changes may be sent via mail (excluding e-mail) to: SureHealth, PO Box 15398, Plantation, FL 33318, or sent via fax to 954-315-6325.

Cancellations: All cancellations shall be requested in writing and shall be delivered via mail (excluding e-mail) to SureHealth, PO Box 15398, Plantation, FL 33318 or via fax to 954-315-6325. You are given a ten (10) day "Free-Look” period to review your plan and cancel with a full refund of your initial monthly payment. The first day of the Free-Look Period shall be determined using the date of application plus 4 days - allowing for standard mail delivery. The one-time association enrollment fee and first monthly administration fee are non-refundable after seven days. The first day of the refund period for the one-time association enrollment fee and first monthly administration fee shall be determined using the date of application. The date of a cancellation shall be determined by either the date stamp of a request received by fax, or the date stamped postmark on requests received through the mail. A cancellation within the Free-Look Period shall be determined if the date stamped on the cancellation request falls within the first 14 days after the date of application. After the ten (10) day “Free Look” period, any cancellation request must reach us at least two days prior to your next Monthly payment due date to prevent another automatic bank draft. When a written cancellation is received after your first effective month of membership, your membership record shall be reviewed. If there is a payment posted for a full future month’s coverage, the payment and administration fee shall be fully refunded.

Exceptions: Colorado residents shall receive a refund of the enrollment fee, administrative fee and initial monthly payment if the written cancellation is received within 30 days of the date of application. Kentucky residents shall receive a full refund of the enrollment fee, administrative fee and initial monthly if the written cancellation is received within 14 days of the date of application plus 4 days - allowing for standard mail delivery. Georgia, New Mexico, and Wyoming residents shall receive a full refund of the enrollment fee, administrative fee and initial monthly payment if the written cancellation is received within 10 days of the date of application plus 4 days - allowing for standard mail delivery. Ohio residents shall receive a refund of the enrollment fee and administrative fee if the written cancellation is received within 7 days of the date of application plus 4 days and a refund of the initial monthly payment if the written cancellation is received within 10 days of the date of application plus 4 days -additional days allow for standard mail delivery. Pennsylvania and Nebraska residents shall receive a refund of the enrollment fee and first monthly administrative fee if the written cancellation is received within 5 days of the date of application plus 4 days and a refund of the initial monthly payment if received within 10 days of the date of application plus 4 days - additional days allow for standard mail delivery.

Refunds: Any refund to which a member may be entitled shall be processed within 10 business days from the date the written request for cancellation is received by SureHealth.

Medical Providers: You may seek treatment from any licensed physician or hospital in order to access your insurance-based benefits. You may see any participating provider of goods and services in order to access your Membership Benefits. Regardless of benefit, you are responsible for the full payment of services provided by a participating provider and any related expenses. Note: Insurance Based Benefits are assignable. As a service, CHCA is willing to search for a contracted, membership provider through CHCA affiliated relationships, but savings may vary from state to state and the provider’s participation is subject to change at any time without notice. CHCA does not warranty or guarantee appropriate credentials of participating providers and assumes no liability or obligation for the credentialing of participating providers. CHCA does not guarantee or warrant the quality or accessibility of discounted services delivered to our members by any affiliated network provider. The sole obligation of CHCA under this Agreement is to perform any requested search for a participating provider in our affiliated networks and provide the results to the Member. SureHealth Plus Plan membership benefits cannot be utilized in conjunction with any other membership programs. Actual savings shall vary, depending upon your location and specific services, products or benefits purchased.

Insurance Policies: All association insurance-based benefits are group policies issued by licensed insurance companies. To receive a reimbursement, you must complete and submit standard claim forms, which shall be mailed to the insurance company or its designated third party administrator (TPA) in order to receive payment for covered services up to the plan maximum or you may choose to assign your association insurance-based benefits to your provider.

Maximum Benefits: Any Member that has collected the lifetime maximum benefit of any insurance based benefit provider affiliated with CHCA shall not re-enroll as a member of any other insurance based benefit provider affiliated with CHCA. Any Member that has collected the annual maximum of all benefits combined shall not re-enroll in any other CHCA affiliated insurance based benefit provider within the same yearly benefit period. If a Member re-enrolls in an affiliated program, CHCA reserves the right to deny further annual and / or lifetime benefits to the Member without further notice.

Governing Law: This Agreement shall be governed and construed in accordance with the laws of the State of Florida. Venue for judicial enforcement or review shall lie in any court of competent jurisdiction in Broward County Florida. Any dispute arising from or relating to the Agreement, which can not be resolved after the parties use reasonable efforts to reach a mutually agreeable understanding, shall be resolved through binding, non-appealable private arbitration, conducted in accordance with the rules of the American Arbitration Association and subject to the Florida Arbitration Code. Exclusive venue for such arbitration shall be in Broward County, Florida, unless otherwise designated by CHCA or its successors. Members shall submit all grievances in writing via U.S. Mail to corporate headquarters and shall mail grievances to the following address: PO Box 15398, Plantation, FL 33318. These provisions shall survive termination of membership in CHCA or in the SureHealth Plus Plan.

This Agreement constitutes the entire Agreement between Members and CHCA. There are no warranties, express or implied, other than those expressly stated herein. Each Member hereby waives any claim he or she may have against CHCA attributable to ministerial or typographical errors. This Agreement may only be amended in writing and only by CHCA. CHCA may, if deemed necessary, assign its duties and responsibilities hereunder to third parties, and shall be relieved of any further liability hereunder. CHCA shall not share your personally identifiable information with the general public. However, CHCA may send promotional information to our Members about services offered by us, our affiliates or our partners.

Insurance Based Benefit Disclosures: (1) Benefits are limited and are not intended to cover all medical expenses. This coverage should not be considered as comprehensive health insurance coverage. This coverage provides limited indemnity benefits to reimburse you for paid expenses covered under your certificate. (2) You hereby requested coverage under the policy issued to the group policyholder by the insurer and understand that if the coverage applied for becomes effective, you agree to all the terms of the group policy. (3) You understand that your Hospital (Room and Board and ICU/CCU), Surgery, and Anesthesia insurance based benefits are not provided for any loss caused by, or resulting from, a Pre-Existing Condition until the end of a continuous period of 12 months (commencing on the Effective Date of Coverage.)

Preexisting Condition is defined as: Injury or sickness, not excluded by name or specific description for which: (a) Medical advice, Consultation, care, or treatment was recommended by or received from a Doctor within 6 months immediately prior to the Effective Date of coverage for a covered person; or (b) Symptoms existed within 6 months immediately prior to the Effective Date of coverage for a covered person that would cause a reasonable person to seek consultation, care, or treatment from a Doctor. Note: Consultation means evaluation, diagnosis, or medical advice given without the necessity of a personal examination or visit. (4) You understand that the marketer, if any, who solicited your application was acting as an independent contractor and not as an agent of the Insurance Company or CHCA. You further acknowledge that the person who solicited your application and upon whose explanation of benefits, limitations or exclusions were relied was retained by you as your marketer, and that such person has no right to bind or approve coverage or alter any of the terms or conditions of the policy. (5) You read your application and have verified that all of the information provided in it as complete, true and correct, and is all within your personal knowledge. (6) You agree to immediately notify CHCA of any changes in any of the information contained in the application, which may occur prior to the approval of coverage. (7) All information you have provided will be held in strictest confidence. Your personal health information is protected at all times and may only be released with your express written authorization to do so.

Miscellaneous Disclosures - General and by State:

Fraud Warning: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, or conceals information for the purpose of misleading may be guilty of insurance fraud and subject to criminal and/or civil penalties. Arkansas Residents: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Colorado Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. District of Columbia Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. Kentucky, Ohio and Pennsylvania Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Louisiana Residents: Fraud Warning: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. NOTICE: Genetic information, receipt of genetic services or refusal to submit to a genetic test may not be used to terminate, cancel, limit, non-renew or deny coverage or establish differentials in premiums. NOTICE: Genetic information, receipt of genetic services or refusal to submit to a genetic test may not be used to terminate, cancel, limit, non-renew or deny coverage or establish differentials in premiums. New Mexico Residents: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES. Oklahoma Residents: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Tennessee Residents: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purposes of defrauding the company. Penalties include imprisonment, fines and denial of coverage. Texas Residents: Fraud Warning: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, or conceals information for the purpose of misleading maybe guilty of insurance fraud and subject to criminal and/or civil penalties.

These Terms & Conditions are subject to change without notice.

ASSOCIATION INSURANCE BENEFITS
PLAN EXCLUSIONS & LIMITATIONS & (ALL PLANS)

Benefits will not be paid for charges or loss caused by or resulting from any of the following:

1. Suicide or any intentionally self-inflicted injury;
   
2. Any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of a doctor (accidental ingestion of poisonous substance is not excluded);
3. Commission, or attempt to commit a felony;
   
4. Participation in a riot or insurrection;
   
5. Driving under the influence of a controlled substance, unless administered on the advice of a doctor;
   
6. Driving while intoxicated (determined by the laws in the jurisdiction of the geographical area where the loss occurs;
   
7. Declared or undeclared war or act of war;
   
8. Nuclear reaction or the release of nuclear energy. This exclusion will not apply if the loss is sustained within 180 days of the initial accident and:
   

   the loss was caused by fire, heat, explosion, or other physical trauma which was a result of the release of nuclear energy; and the covered persons was within a 25-mile radius of the site of the release either at thetime of the release, or within 24-hours of the start of the release, or occurs while he/she is in the state where the original Certificate was issued;

   
   
9. Routine health checkups or immunizations for Covered Person aged 6 and older; expenses for allergies, allergy serum or allergy testing, unless specifically provided for in this Certificate;
   
10. Surgery to correct vision or hearing, eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations or prescriptions;
    
11. Dental care, X-rays, or treatment other than injury to sound, natural teeth and gums resulting from an accidental injury and rendered within six months of the injury;
    
12. Spinal manipulations and manual manipulative treatment or therapy;
    
13. Weight loss or modification and complications arising from, including surgery and other form of treatment for the purpose of weight loss or modification;
    
14. Rest cures or custodial care, or treatment of sleep disorders;
    
15. Treatment, services, or supplies received outside of the United States except for acute sickness or injury sustained during the first thirty days of travel outside U.S.;
    
16. Normal pregnancy or childbirth, except for complications of pregnancy;
    
17. Any drug, treatment, or procedure that either promotes or prevents conception or childbirth regardless of what drug, treatment, or procedure was originally prescribed or intended for;
    
18. Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy;
    
19. Cosmetic surgery. The following types of reconstructive surgery are not excluded:
    

    on an injured part of the body following trauma, infection, or other disease of the involved part; of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or    on a non-diseased breast to restore and achieve symmetry between two breasts following a covered mastectomy;

    
    
20. The repair or replacement of existing artificial limbs, orthopedic braces, or orthotics devices, dentures, partial dentures, braces, or fixed or removable bridges;
    
21. Treatment or removal of warts, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;
    
22. Personal items such as television, telephone, lotions, shampoos, extra beds, meals for guests, take home items, or other items for comfort and convenience;
    
23. Treatment of mental or nervous disorders, or alcohol or substance abuse;
    
24. Prescription medicines;
    
25. Any injury that is caused by flight or travel in or upon;
    

    an aircraft or other craft designed for navigation above or beyond the earth's atmosphere except as a fare-paying passenger; an ultra light, hang-gliding, parachuting or bungi-cord jumping; a snowmobile; any two or three wheeled motor vehicle; any off-road motorized vehicle not requiring licensing as a motor vehicle; any watercraft or other craft designed for water use above or beneath the water, except as a fare-paying passenger;

    
    
26. Any accidental injury where the covered person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator's license (except in a Driver's Education Program);
    
27. Services, treatment, or loss:
    

    rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay; payable by any automobile insurance policy without regard to fault (unless prohibited by state law); which a covered person would not have to pay if he/she did not have insurance; provided by a doctor, nurse, or any other person who is employed or retained by a covered person or who is a member of a covered person's immediate family; covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws; Injury or sickness sustained while on active duty in the armed forces of any country (does not included Reserve or National Guard duty for training).

    
    
28. Elective treatment or surgery and treatment, procedures, products or services that are experimental or investigative. Experimental or investigative means a drug, device, or medical treatment or procedure that:
    

    cannot lawfully be marketed without approval of the United States Food and Drug Administration and approval for marketing has not been given at the time of being furnished; has Reliable Evidence indicating it is the subject of ongoing clinical trials or is under study to determine its maximum tolerated dose, toxicity, safety, efficacy, or as compared with the standard means of treatments or diagnosis; or has Reliable Evidence indicating that the consensus of opinion among experts is that further studies or clinical trials are necessary to determine its maximum tolerated dose, toxicity, efficacy, or its efficacy as compared with the standard means of treatment o diagnosis.