Legal Disclaimers

Affordable Benefit Choices, LLC is an insurance broker, enrollment, and benefits consultation firm. ABC serves as a broker of insurance products or discount medical provider organizations as permitted by applicable state law, and some of the products and/or services recommended in EASE Total Health are discount medical provider organizations. Additionally, ancillary or supplemental insurance products may be offered to interested prospects as licensed and permitted by applicable state law. ABC provides enrollment services for insurance products/discount medical provider organizations, group health plans, and medical benefit services or programs subject to applicable state and/or federal law per item of enrollment. The cash reimbursement benefit is a group indemnity benefit plan sponsored by clients of ABC. Eligibility terms and conditions may apply. ABC is not a third-party administrator and does not adjudicate/adjust claims or collect/direct plan assets, as that term is defined by federal law. ABC is not an insurance carrier and does not cover any claim, benefit, or insurable event. ABC is not a plan sponsor of benefits related to EASE Total Health and does not establish, promise, operate any plan or arrangement for the provision of benefits on behalf of any employer, plan sponsor, group of employers or plan sponsors, or collective of persons outside of the ABC organization itself. ABC operates as an insurance broker in all fifty states as permitted by each state’s licensing and conduct statutes and regulations. Medical services provided or accessed through EASE Total Health are performed by independent third parties with appropriate licenses to provide access to such services. ABC is not a healthcare provider and does not provide medical services.

Client Group Indemnity Plan Disclaimer

NOTE: The following disclaimer is provided by ABC to all of its clients in compliance with Federal regulations for use as dictated by Federal regulations.

EASE Total Health is a combination of the Alpha Data Partners, LP Group Indemnity plan and a collection of subscription-based services and discount programs. The Group Fixed-Indemnity Benefits sponsored by our clients are distinct group fixed-indemnity plans, NOT health insurance. Said plans may pay a limited/fixed dollar amount if an enrollee incurs a triggering event. Enrollees are still responsible for paying the cost of care.

  • The payment received isn't based on the size of the medical bill.

  • There might be a limit on how much such plans will pay each year.

  • Such plans are not considered comprehensive health insurance.

Capitated Benefits Disclaimers

Urgent Care Services (Convenient Care Plus):
This plan is NOT insurance and is not intended to replace health insurance. Convenient Care Plus is a Membership Plan. This plan is not a Qualified Health Plan under the Affordable Care Act. The plan is not available in all states. The discount plan organization is Convenient Care Plus, 210 E 5th St Suite #2 Carroll, IA. 51401, (877) 900-8701. This plan is not available where prohibited by law. Convenient Care Plus has no liability for providing or guaranteeing the medical services or for the quality of the services provided. The plan is governed by the Terms and Conditions of Membership. The range of discounts for medical services offered under the plan varies depending on the type of provider. This plan does not meet the minimum creditable coverage under Massachusetts law.

Our Pledge Regarding Medical Information:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This Notice applies to all of the medical records we receive and maintain. Your personal doctor or health care provider may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. It also describes our obligations and your rights regarding the use and disclosure of medical information to the extent applicable.

We are required by law to:

  • make sure that medical information that identifies you is kept private;

  • give you this Notice of our legal duties and privacy practices with respect to medical information about you; and

  • follow the terms of the notice that is currently in effect.

How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Operations (as described in applicable regulations). We may use and disclose medical information about you for center operations. These uses and disclosures are necessary to run your course of treatment. For example, we may use medical information in connection with: conducting or arranging for medical review, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general administrative activities.

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose medical information when required by a court order in a litigation proceeding such as a malpractice action.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Special Situations
Disclosure to the State. Information may be disclosed to another health plan maintained by the State for purposes of facilitating claims payments under that plan. In addition, medical information may be disclosed to State personnel solely for purposes of administering benefits under the Plan and/or System.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:

  • to prevent or control disease, injury or disability;

  • to report reactions to medications or problems with products;

  • to notify people of recalls of products they may be using;

  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

  • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release medical information if asked to do so by a law enforcement official:

  • in response to a court order, subpoena, warrant, summons or similar process;

  • to identify or locate a suspect, fugitive, material witness, or missing person;

  • about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

  • about a death we believe may be the result of criminal conduct;

  • about criminal conduct at the hospital;

  • in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:

  • Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your benefits. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to your Executive Director. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.

  • Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the System. To request an amendment, your request must be made in writing and submitted to Convenient Care Plus. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: is not part of the medical information kept by us; was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the information which you would be permitted to inspect and copy; is accurate and complete.

  • Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” where such disclosure was made for any purpose other than treatment, payment, or health care operations. To request this list or accounting of disclosures, you must submit your request in writing to Convenient Care Plus. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, paper or electronic).

  • Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. To request restrictions, you must make your request in writing to Convenient Care Plus. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

  • Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Convenient Care Plus. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

  • Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with Convenient Care Plus, or the Secretary of the Department of Health and Human Services. To file a complaint with Convenient Care Plus, or if you have any questions about this Notice, please contact:

Convenient Care Plus
Attn: Kelly Foley, President
12335 Gold Street, Omaha, NE 68144
712-790-2446
KFoley@convenientcareplus.com

Virtual Care Services:
Informed Consent of Services Performed
Telemedicine involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:

  • Patient medical records

  • Medical images

  • Live two-way audio and video

  • Output data from medical devices and sound and video files

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Responsibility for the patient care should remain with the patient's local clinician, if you have one, as does the patient's medical record.
Expected Benefits:

  • Improved access to medical care by enabling a patient to remain in his/her local healthcare site (i.e. home) while the physician consults and obtains test results at distant/other sites.

  • More efficient medical evaluation and management.

  • Obtaining expertise of a specialist.

Possible Risks:
As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:

  • In rare cases, the consultant may determine that the transmitted information is of inadequate quality, thus necessitating a face-to-face meeting with the patient, or at least a rescheduled video consult;

  • Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;

  • In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;

  • In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors;

By using this service, you acknowledge that you understand and agree with the following:
I understand that my consultation with my healthcare provider will be recorded for quality assurance purposes.


I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine, which identifies me, will be disclosed to researchers or other entities without my written consent.
I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.


I understand the alternatives to telemedicine consultation as they have been explained to me, and in choosing to participate in a telemedicine consultation, I understand that some parts of the exam involving physical tests may be conducted by individuals at my location, or at a testing facility, at the direction of the consulting healthcare provider.
I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas, including out of state.


I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes

Patient Consent To The Use of Telemedicine
I have read and understand the information provided above regarding telemedicine, have discussed it with my physician or such assistants as may be designated, and all of my questions have been answered to my satisfaction.


I have read this document carefully, and understand the risks and benefits of the teleconferencing consultation and have had my questions regarding the procedure explained and I hereby give my informed consent to participate in a telemedicine visit under the terms described herein.


By using this service I hereby state that I have read, understood, and agree to the terms of this document.