MEMBER TERMS AND CONDITIONS - SUREHEALTH TRANSITION PLANS

Membership Insurance-Based Features

This Agreement is between you, our valued Member (Member[s]), and Consumer Health Choice Association (CHCA), the sponsor of your SureHealth Membership Program. 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 Membership Programs provide both Membership features and Insurance-based benefits and are available to individuals from age 18 to age 64 with program membership terminating at age 65.

Monthly Payments: As authorized at the time of your application, your Monthly Payments may 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 or about 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, insurance-based benefits and Patriot Health of Florida, Inc. program features. 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 Membership Program.

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: After your first payment and unless you have sent a prior written request for cancellation, if your payment is not paid (honored) on your payment due date, it may be paid during the next thirty-one (31) days. These thirty-one (31) days are called the grace period. If the payment not paid before the grace period ends, the coverage provided by this Policy will terminate at midnight on the last day for which your last payment was paid (honored).

Membership Program Changes: All Membership program changes shall be requested in writing and sent to us via mail (excluding e-mail) to SureHealth Membership Programs, PO Box 15460, Plantation, FL 33318 or sent via fax to 954-315-6325.

10-Day “Free Look” Period Insurance Benefits: You are given a ten (10) day "Free-Look” period to review your Membership program and cancel with a full refund of your initial monthly payment and any monthly association fee charged for the initial month.

Exceptions: Residents of CO are given a thirty (30) day “Free-Look” period. Residents of KY are given a fifteen (15) day “Free-Look” period. The first day of the Free-Look Period shall be determined using the date of the transition notice, plus five (5) days - allowing for standard mail delivery. A cancellation within the Free-Look Period is determined if the date stamped on the cancellation request falls within 15 days (35 days in CO and 20 days in KY) of the date of this notice.

Cancellations: All cancellations must be requested in writing and must be delivered via mail (excluding e-mail) to SureHealth, PO Box 15398, Plantation, FL 33318 or via fax to (954) 315-6325. The date of a cancellation is determined by either the date stamp of a request received by fax, or the date stamped postmark on requests received through the mail. 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 draft. When a written cancellation is received after your first effective month of membership, your membership record will be reviewed. If there is a payment posted for a full future month’s coverage, the payment and any association fee charged will be fully refunded.

Refunds: Any refund to which a member may be entitled will 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 through reimbursement. 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 services delivered to our members by any affiliated network provider. Under this Agreement, CHCA shall only provide access to participating providers in our affiliated network relationships.

Insurance-Based Benefits: The group Insurance-based benefits vary depending on the program selected. These benefits are underwritten by American Medical and Life Insurance Company and are provided under a group insurance policy issued to CHCA and are subject to exclusions, limitations, terms and conditions of coverage as set forth in the insurance certificate, which includes but is not limited to, limitations of pre-existing conditions. This is not basic health insurance or major medical coverage and is not designated as a substitute for basic health insurance or major medical coverage. This is a limited medical Membership program that provides for limitations to the coverage for each feature. The limitations are disclosed in the policy and certificate which is made available to you by calling 1-800-337-1421. To receive a reimbursement, you must complete and submit standard claim forms, which must be mailed to the insurance company's designated third party administrator (TPA) in order to receive payment for covered services up to the Insurance-based benefit maximum or you may choose to assign your association Insurance-based benefits to your provider.

Maximum Benefits: Any CHCA Member that has collected the maximum amounts(s) of any insurance-based benefits affiliated with CHCA shall not re-enroll as a member of another CHCA membership program in order to circumvent the maximum amount(s). If a CHCA Member re-enrolls in an affiliated program, CHCA reserves the right to deny further Insurance-based 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 this 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. Florida Statutes, §95.11 shall apply to any arbitration as the statute of limitations. Exclusive venue for such arbitration shall be in Broward County, Florida, unless otherwise designated by CHCA or its successors. Members may submit all complaints in writing via U.S. Mail to corporate headquarters and may mail complaints to the following address: PO Box 15398, Plantation, FL 33318. These provisions shall survive termination of membership in CHCA and/or in the SureHealth Membership Program. 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 its Members about services offered by us, our affiliates and/or our business partners.

Insurance Based Benefits Disclosures: (1) Insurance-based benefits are limited and are not intended to cover all medical expenses. This coverage is creditable coverage, although it should not be considered as comprehensive health insurance, or major medical insurance coverage. This coverage provides limited indemnity Insurance-based benefits to reimburse you for paid expenses covered under your certificate. (2) You have coverage under the group policy issued to CHCA by the insurer and understand that if the coverage for which you have applied becomes effective, you agree to all the terms of the group policy. (3) You understand that all Insurance-based benefits  (excluding Doctor Office Visits and Preventative Test visits) are not provided for any loss caused by or resulting from a Pre-existing Condition, until such time as there has been continuous period of twelve (12) months (commencing on the initial Effective Date of Coverage in the plan from which you are transitioning.) This limitation does not apply to: genetic information in the absence of a diagnosis of the condition relates to such information; a newborn child who is enrolled in the plan within 30 days after birth; nor to a child who is adopted or placed for adoption before attaining 18 years of age and as of the last day of the 30-day period beginning on the date of the 30-day period beginning on the date of birth, adoption, or placement for adoption, is covered under credible coverage; pregnancy; and an individual, and any dependent of such individual who is eligible for a federal tax credit under the Federal Trade Adjustment Assistance Reform Act of 2002 and who has twelve months of credible coverage. In determining whether a pre-existing condition limitation applies, we will credit the time the covered person was previously covered under creditable coverage if the previous creditable coverage was(a) a group health plan; (b) health coverage; (c) Part A or Part B of title XVIII of the Social Security Act; (d) Title XIX of the Social Security Act other than coverage consisting solely of benefits under section 1928; (e) Chapter 55 of title 10, united States Code; (f) a medical care program of the Indian Health Service or of a tribal organization; (g) a state health benefits risk pool; (h) a health plan offered under chapter 89 of title 5, United States Code; (i) a public health plan, including health coverage provided under a plan established or maintained by a foreign country or political subdivision ( as defined in regulations); (j) a health plan under section 5 (e) of the Peace Corps Act 22 U.S.C. 2504 (e) and coverage under S-CHIP. Pre-existing Condition is defined as the following: injury or sickness, not excluded by name or specific description for which (a) medical advice, consultation, care, or treatment was recommended by and/ or received from a doctor within six (6) months immediately prior to the Effective Date of coverage for a covered person, or (b) symptoms existed within the six (6) month period 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. Consultation is defined as an evaluation, diagnosis, or medical advice given without the necessity of a personal examination or visit. (4) You understand that any marketer soliciting 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 soliciting your application and upon whose explanation of Insurance-based benefits, limitations or exclusions upon whom you 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 group policy. (5) You verified that all of the information provided in your application was complete, true and correct, and was all within your personal knowledge. (6) You agree to notify CHCA immediately of any changes in any of the information contained in the application. (7) All information you have provided shall be held in the strictest confidence. Your personal health information is protected at all times and may only be released with your express written authorization to do so. SureHealth Transition Membership Programs are not available in CT, KS, MN, MT, NH, NJ, NV, SD, VT and WA.

Miscellaneous Insurance 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. 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-based 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. 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.

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MEMBER TERMS AND CONDITIONS (Continued)

Patriot Health Florida, Inc. Program Features*

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

This discount program is not a health insurance policy and is not intended as a substitute for insurance. The program provides for discounts on health services from participating providers, and the range of the discounts will vary depending on the type of provider and the health services received. The program does not make payments to providers of health care services. Members are required to pay for all health care services at the time the services are performed, but will receive a discount from contracted providers. This program is administered by Patriot Health Florida, Inc., at 160 Eileen Way, Syosset, NY, 11791 at 866.907.7851 and is offered to members of Consumer Health Choice Association, located at 8201 Peters Road Suite 1000, Plantation, FL 33324. To obtain additional information and an up-to-date list of contracted providers by name, city, state, and specialty in your service area, you may call customer service at 800-290-3869. Program administrators have no liability for providing or guaranteeing service or for the quality of service rendered. Participating providers are subject to change without notice and are not available in all areas.
Note: This contract is not protected by any state Life and Health Guarantee Association.

Description: Your CHCA SureHealth Membership Program provides Patriot Health Florida, Inc. Program Features* in addition to your Membership Insurance-based benefits. Patriot Health Florida, Inc. Program Features* “Trial Period” Refunds: Residents of AR, IL, IN, ND, NY, OH, OK, SC, TN and TX are entitled to a 30-Day Trial Period to review these features. A cancellation received after the Insurance 10-Day Free Look Period but within 35-Days of this notice of enrollment, allowing 5 days for standard mail delivery, will be considered having been received during the Trial Period and the member may receive a refund of the cost of the Patriot Health Florida, Inc. Program Features*. Residents of AR, IL, IN, NY, OH, SC, TN and TX who cancel during their Trial Period may receive a refund of ten dollars ($10.00). Residents of OK and ND may cancel at any time and receive a refund of ten dollars ($10.00).

Cancellations: All cancellations must be requested in writing and must be delivered via mail (excluding e-mail) to SureHealth, PO Box 15398, Plantation, FL 33318 or via fax to 954-315-6325. The date of cancellation is determined by either the date stamp of a request received by fax, or the date stamped postmark on requests received through the mail. After the Trial Period, any cancellation request must reach us at least two days prior to your next Monthly payment due date to prevent another automatic draft. When a written cancellation is received after your first effective month of membership, your membership record will be reviewed. If there is a payment posted for a full future month’s features, the payment and any association fee for that month will be fully refunded. Refunds:Any refund to which a member may be entitled will be processed within 10 business days from the date the written request for cancellation is received by SureHealth.

Discount Medical Providers: You may see any participating provider of goods and services in order to access your discount medical features associated with your Membership program. You are responsible for the full payment of services provided by a participating provider and any related expenses. Discount medical features associated your Membership program are not available in all states. Savings may vary. Any 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. Under this Agreement, CHCA only provides access to participating health care providers who have contracted with the discount medical plan organization as set forth above.

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 this 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. Florida Statutes, §95.11 shall apply to any arbitration as the statute of limitations. Exclusive venue for such arbitration shall be in Broward County, Florida, unless otherwise designated by CHCA or its successors. Members may submit all complaints in writing via U.S. Mail to corporate headquarters and may mail complaints to the following address: PO Box 15460, Plantation, FL 33318. These provisions shall survive termination of membership in CHCA and/ or in the SureHealth Membership Program. 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 its Members about services offered by us, our affiliates and/ or our business partners.

These Terms & Conditions are subject to change without notice.

*Patriot Health Florida, Inc. Program features are not available in CA, CT, FL, ID, KS, ME, MT, NH, NV, VT and WA. Exception: Pharmacy feature is available in FL, ID and ME but is not available in CA, CT, KS, MT, NH, NV, TN, VT and WA.