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Discount Health Benefits Disclosure. This plan is NOT insurance. This plan is not a qualified health plan under the Affordable Care Act (ACA). Some services may be covered by a qualified health plan under the ACA. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This is not a Medicare prescription drug plan. The plan provides discounts at certain health care providers of medical services. The 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 plan organization. The range of discounts will vary depending on the provider type and services provided. The discount plan organization is Gallagher Affinity Insurance Services, Inc., at 2850 W. Golf Road, Rolling Meadows, IL 60008, 1-888-868-6199. To view a list of participating providers visit www.americandentaldiscounts.com. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid. Such refunds are issued within 30 days of cancellation.

This plan is not available in AK, CT, IA, MA, RI, UT, VT, WA.

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