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Disclosures: This discount program is NOT a health insurance policy or a Medicare prescription drug plan and does not make payments directly to medical service providers. The program provides discounts at participating providers for medical services. Members are obligated to pay for all medical services, but may receive discounts on medical services from participating providers and the discount range will vary depending on provider type and medical services received. The program does not meet the minimum creditable coverage requirements under Massachusetts G.L. c. 111M and 956 CMR 5.00 and is not a Qualified Health Plan under the Affordable Care Act. For residents of CO, FL, IN, LA, MD, MO, NH, NY, OH, TN, TX, UT, VT, and WV, if you cancel your membership within the first 30 days after the effective date of enrollment in the plan, you will receive a reimbursement of all periodic charges upon return of the discount card to Avia Dental Plan, Inc. This reimbursement will include the processing fee for residents of TN and VT. This contract is not protected by any state guaranty fund. The program and program administrator is not liable for providing or guaranteeing health services or for the quality of health services rendered. Membership and processing fees apply. This program is governed by the Membership Agreement provided upon the effective date. Participating providers are not available in all areas and are subject to change without notice. Program is not available in all states. The discount medical plan organization is Avia Dental Plan, Inc., 2001 Main Street, Suite 403, Wheeling, WV 26003, 1-888-431-2273, cancellations@aviadental.com, www.aviadental.com.

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