Member Participation Agreement

As a member of the NCE Dentachoice 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 Monthly fee for Household is $29.99. The One Time Non-Refundable Processing Fee is $0.00.

(Customer Service: 877-271-6559)

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.ncedentachoice.com or you may call 877-271-6559. You will be able to access DMP discounts at participating providers of each participating network.

This DMP includes discounts for: Dental, Vision, Prescriptions. Depending on your plan selection you may not have access to all of these benefits. The included Benefit Description(s). Dental Discounts may range between 15% to 50% per visit on most dental procedures. Vision Discounts between 10% to 50% on vision care, Prescription discounts up to 60%. 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.

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 your 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 NCE Dentachoice for notice of change in name or address by calling 877-271-6559.

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 877-271-6559.

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 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 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 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.

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