Terms, Conditions and Disclosures
This plan is not insurance. This document describes the terms, conditions and disclosures of Your plan (“Program”). It is not a contract. Gallagher Affinity Insurance Services, Inc. (“Gallagher”)
is the benefit administrator of Your plan.
Gallagher will provide You with a listing of participating providers. You will excuse Gallagher from any liability for errors in such listings.
Providers are subject to change without notice. You are responsible for choice of provider, verification that the provider is a current participant and for payment for goods and services.
No portion of any provider’s fee will be reimbursed or otherwise paid by Gallagher. You are solely responsible for payment.
Savings are based on the provider’s usual fees or on national or regional fees for the service or product.
Actual savings will vary depending upon Your location and the specific products or services purchased.
Providers may offer certain products or services to the general public at prices lower than the Program price.
In that event, members will always be charged the lower price. This is a discount program and not insurance.
Program discounts cannot be used in conjunction with any other network based program.
Although Gallagher screens participating providers to ensure appropriate credentials and qualifications to provide goods and services,
Gallagher does not otherwise guarantee nor is responsible for the quality of such service or product purchased by You.
Gallagher reserves the right to modify any benefits included in Your Program, but will make every attempt to replace any benefits with a comparable benefit.
Membership is not transferable. You have a family membership. Only You and Your immediate family may use the membership. “Immediate family” means You, Your spouse and children living at Your home.
Should a single member wish to add family members, call the customer service number shown on the membership I. D. Card.
Termination and Cancellation. You may terminate Your membership at any time by calling us at the toll free number on Your membership card or You may notify us in writing at Member Services, 2850 W. Golf Road, Rolling Meadows, IL 60008.
Your cancellation will be effective promptly upon the receipt of Your cancellation notice.
Governing Law and Arbitration. Your membership is governed and controlled by the laws of the State of Illinois.
Any dispute arising from or related to Your membership shall be resolved by binding, non-appealable private arbitration conducted in accordance with the Rules of American Arbitration Association in Chicago, Illinois, unless required by a member’s individual state laws to resolve in a different location.
This provision shall survive the termination of Your membership and shall be subject to the Federal Arbitration Act.
Governing Law and Arbitration for Montana Residents. Your membership is governed and controlled by the laws of the State of Montana.
Any dispute arising from or related to Your membership shall be resolved by a voluntary private arbitration conducted in accordance with the Rules of the American
Arbitration Association in the State of Montana. This provision shall survive the termination of Your membership and shall be subject to the Federal Arbitration Act.
Disclosure. This plan is NOT insurance. This is not a qualified health plan under the Affordable Care Act.
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 medical plan organization. The range of discounts for services will vary depending on
the type of provider and services. This plan is administered by Gallagher Affinity Insurance Services, Inc., a discount medical plan organization at 2850 W. Golf Road,
Rolling Meadows, IL 60008, 1-800-421-2537. This plan has been provided at no cost to you and will remain active until you call customer service to cancel.
This is not insurance