IMPORTANT INFORMATION, DISCLOSURES, AND DISCLAIMERS

Renewal Conditions: By enrolling into the Consumer Driven Benefits Association (hereinafter referred to as the Association or CDBA), you are agreeing to the Member’s Terms and Conditions shown below.  Your membership will automatically renew every month and your credit card or bank account will be automatically charged or drafted for the appropriate amount on the 20th of the month prior to the monthly renewal.

Termination Conditions: The CDBA reserves the right to terminate plan members from its plan for any reason, including non-payment.

Cancellation Conditions: You have 30-days from the date of enrollment to view the membership benefits.  If for some reason within 30-days you are dissatisfied with the benefits and wish to cancel and obtain a refund of any membership fees paid, please send a cancellation letter and a request for refund with your name and member number to Member Services, Consumer Driven Benefits Association at 515 New Jersey Street, Suite G, Redlands, CA 92373. Requests for termination need to be received in our office by the 15th of the month prior to the 1st of the next renewal period.  One time enrollment and processing fees are non-refundable.  You can also FAX a written request for termination to 909-335-8469.  All cancellation requests must be made in writing.

Limitations, Exclusions & Exceptions: This medical discount program is a discount membership offered by the CDBA.  The CDBA 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 the CDBA.  The CDBA is not licensed to provide and does not provide medical services or items to individuals. You will receive discounts for medical services at certain health care providers who have contracted with the CDBA. You are obligated to pay for all health care services at the time of your appointment.  Savings are based upon the provider's usual and customary fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. 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 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 program. 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 is a participant in the program. At any time the CDBA has the right to eliminate a Participating Professional from the respective network in which they are associated and may substitute Provider networks at its sole discretion. The CDBA cannot and does not guarantee the continued participation of any provider. If he or she leaves the plan, you will need to select another provider. Providers contracted by the CDBA are solely responsible for the professional advice and treatment rendered to members and the CDBA disclaims any liability with respect to such matters. Services and service providers may change or be discontinued at anytime without notice.

Complaint Procedure: If you would like to file a complaint or grievance regarding your plan membership, you must submit your grievance in writing to: Member Services, Consumer Driven Benefits Association, 515 New Jersey St. Suite G, Redlands, CA 92373.  A complaint or grievance can also be FAXED to our offices at 909-335-8469.  More information is available in your “Guide to Member’s Benefits” handbook.

Disclosure:
1) This medical discount benefits are not a health insurance policy.
2) CDBA Membership provides discounts at certain healthcare providers for medical services.
3) The CDBA does not make payments directly to providers of medical services.
4) The CDBA member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount medical plan organization.
5)  The benefits of the Association are not intended to replace health insurance.

This plan is administered by the Consumer Driven Benefits Association, 515 New Jersey Street Suite G, Redlands, CA 92373. The program and its administrators have no liability for providing or guaranteeing service or the quality of service rendered. Note to Utah residents: “This contract is not protected by the Utah Life and Health Guaranty Association”.

Additional information, disclaimers, and disclosures:

1.  The discount medical benefits are NOT a health insurance policy.
2.  Applicable state law on "free look" periods apply. Typically, if your state has this provision, you may get a full refund of your first month's fees if you cancel within 30 days of the date you completed and signed the enrollment application, less a reasonable enrollment fee.
3.  The material on this website is designed for informational purposes only and merely summarizes the benefits available.
4.  IF YOU CURRENTLY HAVE HEALTH INSURANCE, the benefits of the Association are not intended to replace health insurance.  If you cancel your insurance you might not be able to secure full health insurance coverage in the future if an illness or accident occurs. We suggest you consult your insurance agent or company benefits administrator before canceling your health insurance.
5.  The administrator of the fully insured supplement insurance policies such as Accident, Disability, Critical Illness, AD&D, Term Life Insurance, Hospital Reimbursement, Indemnity Dental, and all other group insurance policies is responsible for determination of benefits and payment of claims.  See the "Guide to Member Benefits" for specific claims filing information.  In all cases, payment of benefits is determined by the master group policy definitions, procedures, and amendments in place at the time of claim.  Eligibility for Emergency Medical Air Rescue Services and Emergency Travel Assistance, provided by Life Guard, is effective after 30-days enrollment into the Association.  (NOTE: Emergency Medical Air Service is limited by law to $2,500 in Hawaii and Alaska.)

Notice to New Hampshire residents: If you utilize the discount portion of our program toward hospitalization, Members must secure payment with a major credit card or health insurance plan, if any. Cases in excess of $2000 may require a bank wire transfer of funds or certified funds prior to a referral being issued. In some states members will be required to make a minimum $1000 deposit to the hospital for each day scheduled for in-patient hospital services. (Deposit will be applied against total bill).

The Association - Privacy Practices Notice
The Association appreciates the trust you place in us. You trust us with private personal information and we recognize our obligation to keep information about you secure and confidential. To provide you with the highest quality products and services, we must collect a certain amount of personal information about you. It is important for you to know that we do not sell or share customer information with outside marketers. Our information sharing practices are designed to protect the confidentiality of your information.

We collect personal information you provide on applications or other forms, such as your name, address, financial or bank account information, and social security numbers.  We treat your information with respect and concern for your privacy. We do not disclose any non-public personal or financial information about our customers or former customers to anyone, except as required or permitted by law. In addition to reasonable electronic security measures, our security practices include limiting access to those employees, independent representatives, and business associates with appropriate authority and intended business purposes only.

If we allow limited access or any type of disclosure to permitted persons, it is done to service your benefits, claims, or to inform you about other products and services we offer. Before disclosing your information, we require these companies or individuals to promise to follow our privacy and use it only for the transaction we request.
Acknowledgement
By applying for Association Membership, the member or primary member completing the application understands, acknowledges and agrees to the following:
My lawful spouse and dependents over the age of 18 listed on my enrollment application have read the application and have provided complete and accurate information submitted on the application.  In addition, I did everything to ensure that all the information provided is true and accurate to the best of my knowledge as of the date signed.  I understand and agree that I alone am responsible for the accuracy and completeness of the application.  I understand and agree that no one listed on the application will be eligible for benefits if any information is false or incomplete and that the Association may revoke my membership and benefits if it discovers that any information on the application is incomplete or false.
I accept full legal and financial responsibility for the information provided on the application.  (Court documents establishing guardianship must be submitted, if the responsible adult is not the parent.)
I personally read and completed the application.  The application is a part of the contract between the Association and me, the member or the primary member for a family.  All enrolled family members and I agree to abide by the members’ terms and conditions of that contract.
Arbitration:
The member agrees that any dispute between a member and the Association must be resolved by binding arbitration if the amount in dispute exceeds the jurisdictional limits of the Small Claims Court. Any such dispute will be resolved not by lawsuit or resort to court process, except as the law provides for judicial review or arbitration proceedings.  Under these conditions, both the member and the member’s enrolled family, and the Association are giving up the right to have any dispute in a court of law before a jury.  The Association and the member also agree to give up any right to pursue on a class basis any claim or controversy against the other.
Notice to Members:
It is important that you carefully read the Guide to Member’s Benefits. Failure to read and understand your benefits could cause you to pay a lot more for healthcare services and other personal and business benefits.

Association Member Terms and Conditions
The member understands and acknowledges the following:

  • The access to discount medical benefits are provided with the 1000 membership level in the Association and are available to the member and member's dependents as long as the member follows the procedures outlined in the "Guide to Member Benefits".  Any savings received is through the pre-pay arrangement provided by the Association's contracts and is not an insurance plan.  Association Membership provides access to discounted savings for doctor visits, laboratory and diagnostic testing, hospitalization, and surgical savings only by following the procedures contained in the "Guide to Member's Benefits".  By agreeing to pre-pay for medical services, members access the negotiated fee schedule and receive a substantial savings from the usual, customary, and reasonable (UCR) fees normally charged.  Actual savings varies depending on the nature of the services or treatment received and by the area of the country in which the services were performed.  The Association does not make any payments to health care providers.  The discount medical benefits provided at no cost to Association Members are not an insurance policy.
  • The Association Outpatient Reimbursement Benefit (OBR) is a pre-paid benefit limited to a maximum amount per year and is a vested benefit.  See the "Guide to Member Benefits" for complete benefit description, annual limitations, and vesting requirements.  Members must use the services of the Pre-pay Laboratory and Diagnostic Testing Benefit Testing, and the vesting schedule applies.
  • The Association Doctor Office visit reimbursement benefit is a pre-paid benefit limited to a maximum number of office visits per year and the maximum amount of the reimbursement is up to $50.  The benefit is also a vested benefit according to the schedule shown in the "Guide to Member Benefits".
  • For outpatient services, the Association has a participating provider network that guarantees a minimum 20% discount for services rendered; however, if the member wishes to use a doctor that is not a participating provider, the member is free to do so but the member does not receive a discount unless the member negotiates one with the non-participating provider.  If the member uses a non-participating provider, they can still request reimbursement for the doctor's office visit consultation.  See the "Guide to Member Benefits" for complete benefit description, annual limitations, and vesting requirements that apply.
  • The discounted ancillary healthcare benefits such as dental, vision, hearing, chiropractic, etc provide discount savings to members through a number of healthcare providers that have agreed to provide the savings for payment at the time of service.  For members to qualify for and capitalize on the savings, the member must use a participating provider and pay the providers at the time of service through an HSA or bank draft, payment by check, cash, or by providing a credit card for prompt payment.  The savings members receive varies by provider and area of the country.  If full payment cannot be made at the time of service, it is the responsibility of the member to negotiate satisfactory arrangements with the provider for payment.
  • The savings on hospitalization or surgery can only be utilized when members follow the instructions in the "Guide to Member Benefits".  Although the hospital mediation service will negotiate after your hospital stay or surgical procedure, all members are encouraged to contact the hospital mediation service PRIOR to going into the hospital or surgical center for services.  If a member fails to contact the hospital mediation service prior to receiving treatment or services or if it was due to an emergency, please do so as soon as possible after discharge from the hospital.  The earlier the mediation negotiator can contact your hospital, the better the chances of securing maximum savings.
  • Neither the Association nor any of its affiliates or representatives shall make or be liable for any payment to a provider accessed under the healthcare benefits.  Provider contracts allow the providers the right to terminate participation without notice in the program reserving the right to refuse offering a discount or the negotiated fees to a member.  (NOTICE: It is very rare for a provider to refuse to provide a discount when the member offers to pay the discounted amount at the time of service...should this problem occur, ask the provider to telephone our office and ask for provider relations.) The Association, its affiliates, and providers accessed through your Association membership are not an insurer, guarantor or underwriter for the responsibility or liability for the member's medical care or any other goods or services provided to the member.
  • The Providers of our medical discount benefits are subject to change without notice.  The member or dependent must call a participating provider (when applicable) prior to scheduling an appointment and present their membership ID card at the time of treatment.  See section 1 of the "Guide to Member Benefits" for more information on locating a provider participating in our medical discount program, visit our website, or call 888-350-1500 and follow the voice prompts.
  • Participating healthcare providers are independent contractors.  The Association, its affiliates, and representatives are not responsible for health care provided or the omission of any care by a provider.  The Association does not practice medicine or in any manner interfere with or participate in the provider-patient relationship.  All health care decisions are between the patient and the provider.  The selection of a provider is the obligation and decision of the member and is not based upon the credentialing or any recommendation by the Association, its affiliates, or representatives.
  • The Association reserves the right to terminate membership or deny eligibility in the program for failure to promptly pay a provider or failure to pay the monthly Association fee.  Returned checks or insufficient funds notice on a returned bank draft, is evidence of non-payment by the member.
  • Association membership is on a month-to-month basis.  Members may cancel their membership at any time upon providing written notice 10-days prior to their next billing date.  Termination from the Association will be effective on the next renewal date. The Association's 1-time nominal enrollment and processing fee is non-refundable.
  • For accounting purposes all effective dates are the 1st of the month and renewal billing is due and payable on the 15th of the month preceding the next month's renewal.  If payment is not received or honored by the 25th of the month, the member and all benefits will be suspended on midnight of the last day of the month.  Payments received after the 25th of the month may cause an interruption of benefits until notification of reinstatement is made and accepted by the providers or insurance companies.  Payments received after the first of the month but prior to the 15th of the month can reinstate membership without a reactivation fee but membership and benefits shall not be activated until the first of the next month.  A request for reinstatement after the 15th of the month may require a reactivation fee.  If membership has lapsed for more than 30-days, a new application and enrollment fee may be required.
  • The Association reserves the right to access a late charge of $15.00 if the Association Fees are not received by the 25th of the month prior to the next renewal date.  Furthermore, the Association reserves the right to access a $25.00 charge for returned checks or from insufficient funds on automatic bank drafts.
  • The administrator of the fully insured supplement insurance policies such as Accident, Disability, Critical Illness, AD&D, Term Life Insurance, Hospital Reimbursement, Indemnity Dental, and all other group insurance policies is responsible for determination of benefits and payment of claims.  See the "Guide to Member Benefits" for specific claims filing information.  In all cases, payment of benefits is determined by the master group policy definitions, procedures, and amendments in place at the time of claim.  Eligibility for Emergency Medical Air Rescue Services and Emergency Travel Assistance, provided by Life Guard, is effective after 30-days enrollment into the Association.  (NOTE: Emergency Medical Air Service is limited by law to $2,500 in Hawaii and Alaska.)
  • The initial Association membership fee is guaranteed for 6-months.  Increases in Association fees may be changed for all members within a membership level and/or group within a membership level, (but not individually), upon 30-days notice.  However, if you have upgraded the basic Association membership level with supplemental insurance protection, the monthly membership fee is subject to increases by any rate increase the Association incurs on any supplemental insurance plan at the annual policy renewal dates.  This could cause the monthly membership fee to be increased within the 6-month guarantee period.  The six month guarantee applies only to the basic Association benefits.
  • The member acknowledges the ScriptSolutions 5-tier Formulary RX Plan is not an insurance policy.  It is a formulary five-tier negotiated fee drug plan and participating pharmacies must be used to have the prescription filled.

Member Inquiries or Complaint Procedure
If you have an inquiry concerning your benefits, access to your benefits, or a complaint you want addressed, please call the customer service number on the front of your membership booklet.  If you unable to reach anyone or do not feel your inquiry is receiving prompt attention, please call the Association at 800-303-8110 and ask for customer service.
The following is the procedure followed by our customer service representatives (CSR).
An inquiry or complaint is a written or documented verbal communication received by anyone in our office, which primarily expresses a grievance.  If you receive a written complaint, please forward it immediately by fax or email to your customer service manager.  Immediately means on the same day…as soon as possible.  The handling of an inquiry or complaint is a top priority of all personnel.
The CSR is instructed to get do the following information:

If you are unsure that the correspondence or verbal issue constitutes a complaint, or if a person wants to speak directly to a supervisor about a complaint, immediately forward the telephone call or correspondence to the Customer Service Manager or proper person for prompt resolution.
All the enrollment organizations are required to keep a customer service log of all inquiries or complaints and follow-up on a timely basis to ensure a satisfactory result.

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