PLANS NOT AVAILABLE IN ALL STATES

Plan 1:	* $2,500 Accident Only
Plan 2:	* $5,000 Accident Only
Plan 3:	* $7,500 Accident Only
Plan 4:	* $10,000 Accident Only

RATES: Monthly Benefit Coverage
	Plan 1	Plan 2	Plan 3	Plan 4
Member	$ 25.95	$ 29.95	$ 35.95	$ 39.95
Member + 1	$ 29.95	$ 35.95	$ 39.95	$ 45.95
Member + Family	$ 34.95	$ 39.95	$ 44.95	$ 49.95
Plus a one time $20.00 non-refundable processing fee per Member/Family Your Account will be billed by: Global Consulting Services (GCS)

Family
Member, Spouse, Dependent children under age 18, or under 23 if a full-time student.


Effective Date
All effective dates will be on the first (1st) of the month. Any enrollment application received by the 25th of the month will be effective on the first of the next month. All enrollment applications received after the 25th will be effective on the first of the following month. Example: Date received - Jan. 26th / Effective date - March 1st.

Payment Policy
Click here to view our payment policy
Your account will be billed by: USBA

Changes in Coverage / Cancellation Policy
For your protection we require that you notify US Benefits Advisors in writing of any status change you wish to make in your coverage. USBA will accept cancellations in writing only. You may cancel your coverage at any time, however you will not receive a refund for any month in which your coverage was in force/active. Change/Cancel Form

Disclosures
Click here to view our disclosures

These statements refer to the Discount Portion of the Plan Only

 This plan is not a health insurance policy.
 This plan provides discounts at certain healthcare providers for medical services.
 This plan does not make payments directly to providers of 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 services received.
 The plan member is obligated to pay for healthcare services but will receive a discount from those healthcare providers who have contracted with the discount medical plan organization.

This plan is administered by VantageAmerica Solutions, Inc. 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.

I have read and understand the Payment Policy

I have read and understand the Cancellation Policy