Hispano Club® Membership Individual Standard
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DISCLOSURES FOR DISCOUNT DENTAL, VISION, LAB AND DIAGNOSTIC IMAGING: These discounts are not available in AK, OK, UT, VT and WA. The discount medical benefits (“The Plan”) are NOT insurance, a health insurance policy or a qualified health plan under the Affordable Care Act. The Plan provides discounts at certain health care providers for medical services or products. The range of discounts will vary depending on the type of provider and service received. The Plan does not make and is prohibited from making members’ payments to providers for medical services or products received under the Plan. The Plan member is required and obligated to pay for the entire discounted rate for the medical services or products but will receive a discount from those health care providers who have contracted with the discount medical plan organization. The Discount Medical Plan/Discount Plan Organization is Alliance HealthCard of Florida, Inc., 2711 North Haskell Avenue, Suite 800, Dallas, TX 75204. You may call 800-565-3827 for more information or visit www.HispanoClub.com to locate participating providers. The Plan will make available before purchase and upon request, a list of program providers and the providers’ city, state and specialty, located in the member’s service area. Alliance HealthCard of Florida, Inc. does not guarantee the quality of the services or products offered by individual providers. Any complaints should be directed to Alliance HealthCard of Florida, Inc. at the address or phone number above. Upon receipt of the complaint, member will receive confirmation of receipt within 5 business days. After investigation of the complaint, Alliance HealthCard of Florida, Inc. will provide member with the results and a proposed resolution no later than 30 days after receipt of the complaint. Note to DE, IL, LA, NE, NH, OH, RI, SD, TX, and WV consumers: If you remain dissatisfied after completing the complaint system, you may contact your state department of insurance. Note to MA consumers: The Plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.