Disclosures: This discount plan is not health insurance. The plan provides discounts at certain health care providers for medical services. The Plan does not make payments directly to providers of medical services. Members are obligated to pay for all health care services at the time the services are performed, but will receive a discount from contracted providers. The Discount Medical Plan Organization is Patriot Health Florida, Inc., located at 160 Eileen Way, Syosset, NY 11791. To obtain additional information and an up-to-date list of contracted providers by name, city, state, and specialty in your service area, you may call customer service 1-(800) 292-3797 or click here . This Plan is not available in all states. Plan administrators have no liability for providing or guaranteeing service or for the quality of service rendered. Participating providers are subject to change without notice and are not available in all areas.
Note to Texas Consumers: Regulated by the Texas Department of Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711; telephone 1-800-803-9202 or (512) 463-6599; website: www.license.state.tx.us/complaints. Note to Illinois Consumers: To file a complaint with the Illinois Department of Insurance please contact 866 445-5364.
THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance. This plan does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act.
Do you understand you are enrolling into a Discount Medical Plan provided by Patriot
Health Florida, Inc., a discount medical plan organization? (yes/no)
The plan is not health insurance and is not available in all states. The plan provides discounts at certain health care providers for medical services and does not make payments directly to the providers of medical services. You are obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with Patriot Health Florida, Inc.
Do you hereby authorize Patriot Health Florida, Inc., as administrator for the plan chosen, to charge your credit card in the amount of ? (yes/no) (Must get a yes response)
If you are not completely satisfied, you may call 1-800 292-3797 to cancel at any time. If you cancel within the first 30 days, your membership fee will be refunded. The one-time member activation fee is non-refundable, except where refund provisions for such are specified by state law. If you cancel, your membership will terminate at the end of the billing cycle for which you have paid.
This information is also available to you on the patriothealth.com website.