Common use of Tobacco Products Clause in Contracts

Tobacco Products. Subscribers enrolled in this plan with an effective date on or after May 1, 2016 are billed their subscriber fee based upon whether they have used tobacco products in the previous twelve (12) months. The subscriber fee for a subscriber that does not use tobacco products is lower than the subscriber fee for a subscriber that uses tobacco products. To be eligible for the non-tobacco subscriber fee, you must complete an attestation. Please call the Medicare Concierge Team to request a Tobacco Attestation form. Contact information is in Section 9. The non-tobacco subscriber fee will be effective on the first of the month following receipt of the Tobacco Attestation form if the form is returned to us by the 15th day of the prior month. We may discontinue this non- tobacco use subscriber fee, in our discretion, concurrent with an Office of the Health Insurance Commissioner (OHIC) filed and approved subscriber fee rate change. We will provide prior written notice of such discontinuance to you. Electronic Funds Transfer (EFT) You can have a $2.00 per month discount applied to your subscriber fee by paying your subscriber fee through an electronic funds transfer (EFT). Funds are withdrawn electronically from your checking or savings account. To have the $2.00 EFT monthly discount applied, you must complete an EFT form and submit it us by the 13th day of month prior to your chosen effective date. Please call the Medicare Concierge Team to request an EFT form be sent to you. Contact information is in Section 9.

Tobacco Products. Subscribers enrolled in this plan with an effective date on or after May 1, 2016 are billed their subscriber fee based upon whether they have used tobacco products in the previous twelve (1212 ) months. The subscriber fee for a subscriber that does not use tobacco products is lower than the subscriber fee for a subscriber that uses tobacco products. To be eligible for the non-tobacco subscriber fee, you must complete an attestation. Please call the Medicare Concierge Team to request a Tobacco Attestation form. Contact information is in Section 9. The non-tobacco subscriber fee will be effective on the first of the month following receipt of the Tobacco Attestation form if the form is returned to us by the 15th day of the prior month. We may discontinue this non- tobacco use subscriber fee, in our discretion, concurrent with an Office of the Health Insurance Commissioner (OHIC) filed and approved subscriber fee rate change. We will provide prior written notice of such discontinuance to you. Electronic Funds Transfer (EFT) You can have a $2.00 per month discount applied to your subscriber fee by paying your subscriber fee through an electronic funds transfer (EFT). Funds are withdrawn electronically from your checking or savings account. To have the $2.00 EFT monthly discount applied, you must complete an EFT form and submit it us by the 13th day of month prior to your chosen effective date. Please call the Medicare Concierge Team to request an EFT form be sent to you. Contact information is in Section 9.