Discounts By Design. Non-Insurance benefits that work for you.

Health & Wealth Assure Plan

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Discount Plan Application

Add Additional Card

Membership includes you and your immediate family. Primary member card and second card included in base price. All members have access to benefits using these two cards.

Additional dependent cards with printed names incur a one-time charge of $1 per card. Please input dependent's names in this area. First dependent name included in base price. If no dependent is indicated member receives two cards in primary members name.

Primary Member Included in Base Price

First Dependent Included in Base Price

Additional Dependant $1

Additional Dependant $1

Credit/Debit Card Number

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Form: DBD18-HAWA

Thank you for signing up for the Health & Wealth Assure Plan. By signing up you agree to pay a one-time set-up fee of $5.00 and a monthly fee of $28.95.

By submitting this form, I acknowledge receipt and acceptance of the disclosures listed below.

Total billed today: $33.95

All fields are required.

Disclosures

Disclosures:
Discount Plan Organization:
New Benefits, Ltd.
Attn: Compliance Department
PO Box 803475
Dallas, TX 75380-3475
800-800-7616

Coast to Coast Vision™ and UHS Chiropractic™ are owned and operated by New Benefits, Ltd.

This plan is NOT insurance. This 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 those healthcare providers who have contracted with the discount plan organization. This plan provides discounts at certain healthcare providers for medical services. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. New Benefits will receive and retain a fee from network providers for eligible prescription, hearing, lab, and imaging purchases. The discount medical card program makes available, before purchase and upon request, a list of program providers, including the name, city, state, and specialty of each program provider located in the cardholder''s service area.

This discount card program contains a 30 day cancellation period.

FL, LA, MS, ND, OK, RI, SC, SD and TX residents: Member shall receive a full refund of membership fees, excluding one-time application fee, if membership is cancelled within the first 30 days after the effective date. UT, AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. MD Residents: The membership fee and one-time application fee (minus $5.00) will be refunded if cancelled within the first 30 days and upon return of the discount card. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR 5.00.

RI residents:
If a resident of the state of Rhode Island remains dissatisfied after completing the organization’s complaint process, the plan member may contact the office of the insurance commissioner at:
Rhode Island Office of the Health Insurance Commissioner
151 Pontiac Avenue, Building 691
Cranston, RI 02920
401-462-9517
OHIC.HealthInsInq@ohic.ri.gov

Regulated discount benefits are not available in the state of Washington, at this time.

WA residents:
If a member cancels his or her membership in the discount plan organization within the first thirty days after the date of receipt of the written documents for the discount plan, the member must receive a reimbursement of all periodic charges upon return of the discount plan card to the discount plan organization.

  • (A) Cancellation occurs when notice of cancellation is given to the discount plan organization. (B) Notice of cancellation is given when delivered by hand or deposited in a mailbox, properly addressed and postage prepaid to the mailing address of the discount plan organization, or e-mailed to the e-mail address of the discount plan organization.
  • (A) Discount plan organization shall return in full any periodic charge charged or collected after the member has given the discount plan organization notice of cancellation. (B) If the discount plan organization cancels a membership for any reason other than nonpayment of charges by the member, the discount plan organization shall make a pro rata reimbursement of all periodic charges to the member.
  • If a resident of the state of Washington remains dissatisfied after completing the organization''s complaint process, the plan member may contact the office of the insurance commissioner at:

    Washington Office of the Insurance Commissioner
    P.O. Box 40256
    Olympia, WA 98504-0256
    800-562-6900
    www.insurance.wa.gov

    Internet website address to obtain participating providers is MyMemberPortal.com.

    For Terms and Conditions, click here.

    RSS

    Not available to UT, VT or WA residents.