TERMS OF MEMBERSHIP AND MEMBER PARTICIPATION AGREEMENT
MEMBER PARTICIPATION AGREEMENT
As a member of Chiropractic Lifecare of America Program, you are a participant in a Discount Medical Program
referred hereafter as the (DMP). Below are the terms and conditions of your membership in the DMP.
This Member Participation Agreement is effective as of the date you receive your identification card and
shall continue as stated on your enrollment form, “monthly”, “semi-annually”, or “yearly”, until the DMP
has been notified of your cancellation.
The charge and mode of payment for participation in the DMP is on your enrollment form. If you need
to change your payment mode, please contact the member services number on your identification card.
The One Time Non-Refundable Processing Fee is: [range from $0.00 to $30.00]
DISCLOSURES
- This plan is a discount plan NOT a health insurance policy.
- This plan provides discounts at certain health care providers for medical services.
- This plan does not make payments directly to the providers of medical services.
- The plan member is obligated to pay for all health care services but will receive a
discount from those health care providers who have contracted with the discount
medical plan organization. - The DMPO does make available an up-to-date list of all program providers which
includes their name, city & state, and medical specialty prior to purchase, upon
request. - That the range of discounts for medical services provided under the plan will vary
depending on the type of provider and the medical services received.
The corporate name and the location of the licensed discount medical plan
organization is: Access One Consumer Health, Inc., 84 Villa Road, Greenville, SC 29615;
800-896-1962; www.accessonedmpo.com
You may find a list of participating providers at: www.clahealthcare.com/index.php/find-a-doctor/or
you may call:1-800-775-7900. You will be able to access DMP discounts at participating providers of
each participating network.
This DMP includes discounts for: [Physician & Non Hospital Services, Dental, Vision, Hearing,
Prescriptions, Chiropractic Care, Ask A Nurse Feature]. Depending on your plan selection you may not
have access to all of these benefits. The included Benefit Description(s). [Physician Non Hospital
Services between 5%-25%, Dental Discounts between 15% to 50% on dental procedures. Vision
Discounts between 10% to 50% on vision care, Prescription discounts up to 60%, Hearing Discounts: up
to 40%. Chiropractic Discounts: up to 50%. Ask A Nurse Feature: the ability to contact the nurse line
provider and speak with a registered nurse 24 hours per day, seven days a week, and 365 days per year.
(Ask A Nurse Feature is NOT available in NY).] The minimum discount for any service provided under the
Plan is 5% and may go to as much as 50%. The Benefit Description(s) becomes part of this Member
Participation Agreement.
You will be billed at the time of service by the participating provider who will apply the applicable
discounts to that bill. In no instance can the DMP make payments directly to the provider on your
behalf.
MEMBER PARTICIPATION AGREEMENT
Your participation in the DMP will continue as stated on your enrollment form: “monthly”, semi-
annually”, or “yearly”, upon payment of your dues and shall cease upon (i) your failure to make the
payment; or (ii) notification in writing (USPS, email or facsimile) of you desire to cancel.
You have the right to cancel participation in the program at any time. If you do so within 30 days of
receipt of your membership materials, you will receive a full refund of all fees and or dues paid to
participate in the DMP minus the one-time non-refundable processing fee. If the processing fee is more
than thirty dollars, it will be refunded. After the first thirty (30) days, you may cancel participation at any
time and if you have pre-paid any membership fees, the prepayment will be refunded on a pro-rata
basis for months you have not used. Notification must be received at least five (5) business days in
advance of the next billing cycle for you not to be charged for that billing cycle.
The DMP may terminate your participation in the program if you fail to make your membership payment
when due.
You may contact Chiropractic Lifecare of America for notice of change in name or address on our website, clahealthcare.com
or calling 1-800-775-7900.
This program includes all members of your household (you your spouse and legal dependents). You are
not required to list your dependents to participate in the DMP. You may add dependents or additional
members of your household by calling 1-800-775-7900.
If you have a complaint regarding the DMP you may go to www.accessonedmpo.com or call 800-896-
1962. You may also write to Access One Consumer Health, Inc. 84 Villa Rd. Greenville, SC 29615. The
complaint will be addressed, and you will receive a response within 15 days. If you are dissatisfied with
the result, you may contact your state insurance department.
This Member Participation Agreement includes an arbitration provision, a waiver of jury trial, and a
prohibition on participation in class actions. These provisions can be found in the Addendum on our
website at www.accessonedmpo.com/member-agreement-addendum/ and are incorporated herein by
reference and made a part of this Member Participation Agreement to the same extent and with the
same force as if fully set forth herein.
This Agreement and its Benefit Descriptions along with the Addendum represent the entire agreement
between you and the DMP and supersede all other prior representations, statements, or written
agreements between you and the DMP.
Arkansas Residents You may cancel your membership with the discount medical plan organization
within the first thirty (30) days from receipt of your ID card and receive a full refund of all fees or dues
paid. Illinois Residents If you are not satisfied with your resolution of your complaint, you may contact
Illinois Department of Insurance. Louisiana Residents If after receiving our response and you are not
satisfied with the resolution you may write of call the Louisiana Department of Insurance. You have the
right to cancel participation in the program at any time. If a member cancels his membership in the
discount medical plan organization within the first thirty days after the date of receipt of the written
document for a discount medical plan, the member shall receive a reimbursement of all periodic charges
and the amount of any one-time processing fee that exceeds thirty dollars upon return of the discount
medical plan card to the discount medical plan organization. Maryland Residents “Discounts for hospital
services, if any, are not applicable in Maryland.” Massachusetts Residents 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. Nebraska Residents If you have cancelled at
any time after the thirty (30) day period, and you have pre-paid any membership fees, the prepayment
MEMBER PARTICIPATION AGREEMENT
will be refunded on a pro-rata basis for months you have not used. New York Residents “Nurseline”
not available in New York.
South Carolina You may cancel your membership with the discount medical plan organization within the
first thirty (30) days from receipt of your ID card and receive full refund on any fees or dues paid, less
the one-time processing fee. Tennessee Residents You may cancel your membership with the discount
medical plan organization within the first thirty (30) days from receipt of your ID card and receive a full
refund of all fees or dues paid. Texas Residents The DMP will cease collecting membership fees in a
reasonable amount of time, but no later than (30) days after receiving a valid cancellation notice.
If you are not satisfied with your resolution of your complaint, you may contact your state insurance
department. Utah Residents These programs are not covered by the Utah Health Insurance Guarantee
Act. West Virginia Residents If after receiving our response and you are not satisfied with the resolution
you may write of call: West Virginia Insurance Commissioner.
This DMP is not available in the following states AK, MT, RI, UT, VT, WA.
MPA AO-V10.23
- Membership Term – A paid Member shall be entitled to all benefits of Chiropractic Lifecare of America (CLA) for a full twelve (12) month
period from the effective date of the card. - Membership Cards – Any additional or replacement cards may be purchased for $10.00 per card.
- Member Service Representations and Obligations – In return for the discount and services available under CLA, all Members acknowledge that
they have read “The Terms of Membership Agreement” carefully, and understand the Membership Terms. - Disclaimer of Warranties – CLA is not a direct provider of the benefits available to Members. ACCORDINGLY IT GIVES NO WARRANTY, EXPRESS
OR IMPLIED, AS TO ANY BENEFITS OR SERVICES OBTAINED BY A MEMBER THROUGH MEMBERSHIP IN CHIROPRACTIC LIFECARE OF AMERICA. EACH MEMBER ACKNOWLEDGES
THAT HE/SHE IS NOT RELYING ON SKILL OR JUDGEMENT IN SELECTING THE BENEFITS AND SERVICES AVAILABLE TO MEMBERS. In the event any benefit of
service purchased by a Member is unsatisfactory to the Member, the Member will look solely to the Chiropractic Lifecare Provider for satisfaction
of claim relative to benefits of services rendered. It is further understood that all services ordered are subject to availability of such
services and any information provided to the Members is subject to change without notice. - General Release – Each member, for himself/herself, and on behalf of any person who uses the benefits or services under the Chiropractic
Lifecare membership (“Membership Beneficiary”), hereby forever releases, acquits and discharges Chiropractic Lifecare of America from any and all
liabilities, claims, demands, actions, and cause of action that such Member or such Member’s legal representatives have by reason of any monetary
damage or personal injury sustained as a result of these benefits or services available under Chiropractic Lifecare of America. The sole recourse
available to a Member, Membership Beneficiary or their legal representative as it relates to Chiropractic Lifecare, shall be the cancellation of
the Chiropractic Lifecare Card and a full refund of the Membership Fee as outlined in CLA Refund Policy below. - Notices – Any and all notices, consents, approvals, requests and other written communications given under the Terms of Membership and
Membership Agreement shall be deemed to have been duly given and served when sent by first-class mail, postage prepaid and addressed to the
Member, at the address shown on the Member’s Application, or to Chiropractic Lifecare of America LLC, 1031 Parkside Commons, Suite 202,
Greensboro, GA 30642. - Entire Agreement – The Foregoing Terms of Membership and Membership Agreement shall be binding on Chiropractic Lifecare of America
and the Member, including their respective successors and contain the entire terms and agreement of Chiropractic Lifecare membership.
No representation, inducements, promises or agreements, or otherwise, between Chiropractic Lifecare of America and the Member not included
herein, shall not be of any force or effect. If any of the foregoing terms or provisions shall be invalid or unenforceable, the remaining
terms and provisions hereof shall not be affected thereby. - Choice of Law – The foregoing Terms of Membership and Membership Agreement shall be construed and enforced in accordance with the Laws
of the State of Georgia. - CLA Refund Policy – The entire cost of your membership will be refunded if you use your network card during your 12-month membership
year and do not save at least the cost of our membership. Simply return your card with a copy of your doctor’s bills for a refund. - Safeguarding Privacy – CLA maintains physical, electronic and procedural safeguards that ensure the safety of customer’s information.
We do not share information. All members acknowledge that they have read, understood and agreed to the
CLA Privacy Policy. - Discount Medical Program Membership – All Members hereby acknowledge that by joining they are a participant in a Discount Medical Program (Plan)
administered by AccessOne Consumer Health, Inc., 84 Villa Road, Greenville, SC 29615 and have read and understood the Member Participation Agreement
(available by clicking this link) and as members will receive unlimited manipulations not to exceed
$40 (typically $30) per manipulation with up to a 50% reduction on other included professional services and supplies. - Comments, suggestions and complaints – Please direct any comments, suggestions or complaints to AccessOne www.accessonedpmo.com.