The Southwest Advantage Discount Plansouthwestservicelife.com/uploads/CorpToFran/SW... ·...
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Renewal Conditions: By joining a plan, you are authorizing Southwest Advantage to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Southwest Advantage in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount. Termination Conditions: Southwest Advantage and Careington reserve the right to terminate plan members from its plan for any reason, including non-payment. If Southwest Advantage terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees. Cancellation Conditions: You have the right to cancel within the first 30 days after receipt of membership materials (FL residents: your 30 days begin after the effective date) and receive a full refund. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Southwest Advantage will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Southwest Advantage, P.O. Box 982005, N. Richland Hills, TX 76182. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in ND and OK, where you will receive a pro-rata refund whenever you cancel. Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan. Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Careington. Careington is 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 by Careington. Careington is not licensed to provide and does not provide medical services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Careington cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Careington are solely responsible for the professional advice and treatment rendered to members and Careington disclaims any liability with respect to such matters. Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Careington International Corporation, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department. Is the Southwest Advantage Discount Plan an Insurance Program? NO, Southwest Advantage Discount Plan is NOT insurance. Our members and their families enjoy the flexibility of these discount savings programs because everyone can use the plan with no limits on use. Southwest Advantage Discount Plan is administered by Careington International Corporation, who uses their national volume power to negotiate and provide significant savings to our members. How soon can I use this Program? In approximately 15 days after joining you will receive your membership card and a Membership Kit describing each of the discount programs and how to use them. You and your family will immediately be able to use your Southwest Advantage Discount Plan program. How do I know which providers will honor the Southwest Advantage Discount Plan membership card? For participating providers nearest you, simply call us toll- free at (800) 290-0523 or visit www.searchforaprovider.com. How do I pay for my Southwest Advantage Discount Plan? A member may mail their monthly payment directly to Southwest Advantage Discount Plan or pay by monthly bank draft. What if I need medical assistance while I am traveling? A toll-free customer service number and website is available to you for information on providers throughout the country or for any other assistance you require in using the program. Can I use the Southwest Advantage Discount Plan even if I have insurance? Yes! In most cases the Southwest Advantage Discount Plan can be used to complement your current Insurance program. If I am on Medicare, can I use the Southwest Advantage Discount Plan? Yes! The Southwest Advantage Discount Plan may provide discounts on the portion of the costs not covered by Medicare. Frequently Asked Questions Terms and Conditions Application The Southwest Advantage Discount Plan FORT WORTH, TEXAS Through your membership with Southwest Advantage Discount Plan, you and your family can access valuable discounts on: • Dental Services • Vision Care • MedImpact Prescription Drugs • Imaging/MRI & CT Scans • Laboratory Tests • Medical Doctor Consultations • Diabetic Care & Supplies • Hearing Care Services • Identity Theft Protection The application, along with your member kit, will serve as your entire membership agreement. MEMBER INFORMATION First Name: ___________________ MI: _____ Last Name: ____________________________ DOB: ________________________________ Social Security Number: _ _ _ _ _ _ _ _ _ Street Address: __________________________ City: _________________________________ State:____________ Zip: _________________ Daytime Phone: _________________________ Evening Phone: _________________________ Email Address: __________________________ MEMBERSHIP FEE (Family members include: member spouse and legal dependents.) Monthly payment by automatic bank draft ... □ $14.90 Monthly payment by mail .............................. □ $15.90 APPLICATION FEE $10.00 - A ONE-TIME, PROCESSING FEE IS REQUIRED WITH EACH APPLICATION. FAMILY MEMBERS (Date of birth required to add spouse and legal dependents.) First Last MI DOB SSN _____________________________________ _____________________________________ _____________________________________ _____________________________________ You can cancel within the first 30 days and receive a full refund, including your processing fee.
Transcript of The Southwest Advantage Discount Plansouthwestservicelife.com/uploads/CorpToFran/SW... ·...
Renewal Conditions: By joining a plan, you are authorizing Southwest Advantage to bill your credit card or checking account for the plan you have selected. This charge shall renew until you notify Southwest Advantage in writing of its cancellation. By joining you indicate you have read the terms and conditions of the plan. This plan will automatically renew at the end of your membership term, and your credit card or bank account will be automatically charged or drafted for the appropriate amount.Termination Conditions: Southwest Advantage and Careington reserve the right to terminate plan members from its plan for any reason, including non-payment. If Southwest Advantage terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.Cancellation Conditions: You have the right to cancel within the first 30 days after receipt of membership materials (FL residents: your 30 days begin after the effective date) and receive a full refund. If for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund, you must submit a written cancellation request. Southwest Advantage will accept cancellation requests at any time and will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a request for refund with your name and member ID to Southwest Advantage, P.O. Box 982005, N. Richland Hills, TX 76182. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in ND and OK, where you will receive a pro-rata refund whenever you cancel.Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.Limitations, Exclusions & Exceptions: This plan is a discount membership program offered by Careington. Careington is 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 by Careington. Careington is not licensed to provide and does not provide medical services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available where prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is the member’s responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Careington cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Careington are solely responsible for the professional advice and treatment rendered to members and Careington disclaims any liability with respect to such matters.Complaint Procedure: If you would like to file a complaint regarding your plan membership, you must submit your complaint in writing to: Careington International Corporation, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department.
Is the Southwest Advantage Discount Plan an Insurance Program?
NO, Southwest Advantage Discount Plan is NOT insurance. Our members and their families enjoy the flexibility of these discount savings programs because everyone can use the plan with no limits on use. Southwest Advantage Discount Plan is administered by Careington International Corporation, who uses their national volume power to negotiate and provide significant savings to our members.
How soon can I use this Program?
In approximately 15 days after joining you will receive your membership card and a Membership Kit describing each of the discount programs and how to use them. You and your family will immediately be able to use your Southwest Advantage Discount Plan program.
How do I know which providers will honor the Southwest Advantage Discount Plan membership card?
For participating providers nearest you, simply call us toll-free at (800) 290-0523 or visit www.searchforaprovider.com.
How do I pay for my Southwest Advantage Discount Plan?
A member may mail their monthly payment directly to Southwest Advantage Discount Plan or pay by monthly bank draft.
What if I need medical assistance while I am traveling?
A toll-free customer service number and website is available to you for information on providers throughout the country or for any other assistance you require in using the program.
Can I use the Southwest Advantage Discount Plan even if I have insurance?
Yes! In most cases the Southwest Advantage Discount Plan can be used to complement your current Insurance program.
If I am on Medicare, can I use the Southwest Advantage Discount Plan?
Yes! The Southwest Advantage Discount Plan may provide discounts on the portion of the costs not covered by Medicare.
Frequently Asked QuestionsTerms and ConditionsApplication The Southwest Advantage Discount
PlanFORT WORTH, TEXAS
Through your membership with Southwest Advantage Discount Plan,
you and your family can access valuable discounts on:
• Dental Services• Vision Care• MedImpact Prescription
Drugs• Imaging/MRI & CT Scans• Laboratory Tests• Medical Doctor
Consultations• Diabetic Care & Supplies• Hearing Care Services• Identity Theft Protection
The application, along with your member kit, will serve as your entire membership agreement.
MEMBER INFORMATION
First Name: ___________________ MI: _____
Last Name: ____________________________
DOB: ________________________________
Social Security Number: _ _ _ _ _ _ _ _ _
Street Address: __________________________
City: _________________________________
State:____________ Zip: _________________
Daytime Phone: _________________________
Evening Phone: _________________________
Email Address: __________________________
MEMBERSHIP FEE(Family members include: member spouse and legal dependents.)
Monthly payment by automatic bank draft ...□ $14.90
Monthly payment by mail ..............................□ $15.90
APPLICATION FEE
$10.00 - A ONE-TIME, PROCESSING FEE IS
REQUIRED WITH EACH APPLICATION.
FAMILY MEMBERS(Date of birth required to add spouse and legal dependents.)
First Last MI DOB SSN
_____________________________________
_____________________________________
_____________________________________
_____________________________________ You can cancel within the first 30 days and receive a
full refund, including your processing fee.
IMAGING & LABORATORY TESTS• Save 40% to 75%* off the usual costs for MRI, CT
scans and PET scans.*2010. Savings may vary based on geographic location, provider selected and procedure performed.
• Largest panel of high-quality radiologists and imaging specialists with over 3,200 outpatient radiology facilities throughout the United States.
• This product is not available in HI, MA, MT, ND, SD and WV.
• This lab program provides savings from 10% to 80% off regular retail pricing on blood tests available at over 3,000 Clinical Laboratory Certified Labs nationwide. This product is not available in New York, New Jersey, Massachusetts and Rhode Island.The Imaging and lab testing discounts are provided by Galaxy Health Network.
VISION CAREVSP Vision Savings Pass is a discount vision program that offers savings on eye care and eyewear. Members receive Exclusive Member Extras and special offers in addition to access to discounts through trusted, private-practice VSP doctors on eye and contact lens exams, glasses, and sunglasses.This plan is not insurance.Not available in WA.
The Vision Care discounts are provided by VSP® Vision Savings Pass.
MEDICAL INFORMATIONDialCare is a modern, easy-to-use telemedicine solution for non-emergency illnesses and general care. Members have direct access to state-licensed and fully credentialed physicians, via phone or video consultations, to receive treatment and advice for common ailments, including colds, the flu, rashes and more. When medically appropriate, a DialCare physician may prescribe a short term, non-DEA controlled medication that they can pick up at the pharmacy of their choice. Physicians are available 24 hours a day, 365 days a year, allowing members and their families convenient access to quality care from home or work.
DENTAL SERVICES• Members may take advantage of savings through the
Aetna Dental Access® network. Aetna is one of the most recognized names in health coverage nationally.
• Members will have access to discounted services and in most cases, can save 15% to 50% per visit on everything from general dentistry to root canals, crowns and orthodontia at over 172,000* available dental practice locations nationwide.*Dentist locations as of September 1, 2017, Aetna Enterprise DatabaseParticipants must pay health care providers directly.
This is NOT insuranceActual Discounts will vary based on the geographic location of the dental provider and the services provided.Careington provides access to Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its affiliates offers or administers the Careington membership. Neither ALIC nor any of its affiliates is an affiliate, agent, representative, or employee of Careington International Corporation. Dental providers are independent contractors and not employees or agents of ALIC or its affiliates. ALIC does not provide dental care or treatment and is not responsible for outcomes. Careington International Corporation: 7400 Gaylord Pkwy, Frisco, TX 75034, 1-800-290-0523.
MEDIMPACT - PRESCRIPTION DRUGS• Members are entitled to prescription savings from
15% to 60% off the retail price of generic drugs and 15% to 25% off the retail price of brand-name drugs at over 62,000 participating pharmacies nationwide.
HEARING CARE SERVICES• Save 40% on diagnostic services, including hearing
exams, at over 3,800 provider locations nationwide.• Hearing aid low price guarantee: If you should find
the same product at a lower price, bring us the local quote and we’ll not only match it, we’ll beat it by 5%!
• 2 years of free batteries (80 cells per hearing aid, per year)The hearing care discounts are provided by Amplifon.
DIABETIC SUPPLIESBetter Living Now, Inc. (BLN) is a managed care provider of healthcare products and services, specializing in the needs of patients with chronic conditions.BLN brings these values to the member:• Free shipping and choice of free gift with first order• Durable Medical Equipment – 20% to 30% off of
retail price• Disposable Medical Supplies – 20% to 40% off of
retail price.The diabetic supplies discounts are provided by Better Living Now.
IDENTITY THEFT PROTECTIONID Experts is a fully managed identity theft restoration service that provides the complete coverage identity theft victims expect and need. The ID Experts team includes experts in every aspect of identity theft, protection, restoration and data breach response management. ID Experts have a 100% record of success in completely restoring identity theft victims to pre-theft status.
The Identity Theft Protection program is provided by ID Experts.
RECEIPTTotal Amount paid for first month’s dues and one-time, $10.00 processing fee:
$ ________________________________
Join the Southwest Advantage Discount Plan today… And start saving on a wide range of services nationwide!
Disclosures: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. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.searchforaprovider.com. A written list of participating providers is available upon request. You may cancel within the first 30 days after receipt of membership materials and receive a full refund, less a nominal processing fee (nominal fee for MD residents is $5, AR and TN residents will be refunded processing fee). Discount Medical Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.This plan is not available in Vermont or Washington.
Easy Payment Options
Total Amount paid for first month’s dues and one-time $10.00 processing fee: $ ____________________________________
(Please make check payable to Southwest Advantage Discount Plan.)
BANK DRAFT
Name of Account Holder: _____________________________________
□ Checking □ Savings
Please include a voided check with this application.
Name of Bank:
_____________________________________
City and State of Bank:
_____________________________________
Routing Number (9 numbers at bottom of check):
____-____-____-____-____-____-____-____-____
Account Number: ________________________
PAYMENT AUTHORIZATION Membership Terms and Conditions
I authorize Southwest Advantage Discount Plan to bill my checking/savings account for this program; it will remain in force until I notify them in writing to cancel. Processing will be delayed on applica-tions without a form of payment. Charges will ap-pear as “Southwest Advantage Discount Plan” on your monthly statement. This application, along with your member kit, with all product details, will serve as your membership agreement. Please keep the brochure portion for your records. You will re-ceive your member kit after we process your appli-cation.
Signature: _____________________________
Date: _________________________________
Agent Name: ___________________________
Agent No.: _____________________________
