Terms of Use

Policy last revised Sept. 25, 2023

Your compliance with these Terms of Use / Online Privacy (“Terms of Use”) is a condition to your use of the Site. If you do not agree to be bound by the Terms of Use, promptly exit this Site. Please consult the Online Privacy portion of these Terms of Use for information regarding our practices with respect to collection, use and sharing of personal information through this Site.

Ownership of the Site

All pages within this Site and any material made available for download are owned or licensed by the Company. The Site is protected by United States and international copyright and trademark laws. The Contents of the Site, including without limitation the files, documents, text, photographs, images, audio, and video, and any materials accessed through or made available for use or download through this Site (“Content”) may not be copied, distributed, modified, reproduced, published or used, in whole or in part, except for purposes authorized or approved by Company, including the provision of services or products to Company, or in connection with a business relationship with Company.

You may not frame or utilize framing techniques to enclose, or deep linking to, any name, trademarks, service marks, logo, Content or other proprietary information (including images, text, page layout, or form) of Company without our express written consent. If you have questions about the Site or any materials or would like more information or to request written consent, please Contact Us or call us at 734-343-1000.

Site Security

You are prohibited from violating or attempting to violate the security of the Site, including, without limitation, (a) accessing data not intended for such user or logging onto a server or an account which the user is not authorized to access; (b) attempting to probe, scan or test the vulnerability of a system or network or to breach security or authentication measures without proper authorization; or (c) accessing or using the Site or any portion thereof without authorization, in violation of these Terms of Use or in violation of applicable law.

Violations of system or network security may result in civil or criminal liability. Company will investigate occurrences that may involve such violations and may involve, and cooperate with, law enforcement authorities in prosecuting users who are involved in such violations. You agree not to use any device, software or routine to interfere or attempt to interfere with the proper working of this Site or any activity being conducted on this Site.

Access to Site; Indemnification

In the event access to the Site or a portion thereof is limited requiring a user ID and password (“Protected Areas”), you agree to access Protected Areas using only your user ID and password as provided to you by Company. You agree to protect the confidentiality of your user ID and password, and not to share or disclose your user ID or password to any third party. You agree that you are fully responsible for all activity occurring under your user ID. Your access to the Site may be revoked by Company at any time with or without cause. You agree to defend, indemnify and hold Company harmless from and against all third-party claims, damages and expenses (including reasonable attorneys’ fees) against or incurred by Company arising out of your use or access of the Site, or access by anyone accessing the Site using your user ID and password.

Accuracy and Integrity of Information

Although Company attempts to ensure the integrity and accurateness of the Site, it makes no representations, warranties or guarantees whatsoever as to the correctness or accuracy of the Site and Content thereon. It is possible that the Site could include typographical errors, inaccuracies or other errors, and that unauthorized additions, deletions and alterations could be made to the Site by third parties.

In the event that an inaccuracy arises, please inform Company so that it can be corrected. Information contained on the Site may be changed or updated without notice. Additionally, Company shall have no responsibility or liability for information or Content posted to the Site from any non-Company affiliated third party.

Medicare Plans

The Medicare Advantage and Medicare Part D plans are health plans with a Medicare contract or a standalone prescription drug plan with a Medicare contract. The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. All Medicare Plan benefits are subject to the terms, conditions and limitations of the specific Evidence of Coverage issued, including, but not limited to, eligibility, enrollment, prior approval, exclusions and limitations, and medical necessity requirements. For further information on a policy and its limitations, please contact our Member Services Department at 1-800-240-3851.

Important Information for Members with Medicare Part D Coverage

Your Evidence of Coverage shows what is covered and what you pay for your Part D prescription drugs.

The coverage gap begins after you and your Medicare Part D or Medicare Advantage Prescription Drug plan together have spent a certain amount for covered prescription drugs. You can check the Evidence of Coverage to find out the amount you pay to reach the Part D coverage gap phase. The cost share for the Part D coverage gap phase will continue as shown in your Evidence of Coverage until you and the Medicare Coverage Gap Discount Program together have spent the amount for covered Part D prescription drugs which reaches the threshold.

Important Information for Members with Medicare Part D Coverage Who Also Qualify For “Extra Help”

"Extra Help" is a Medicare program that works with a Medicare Part D plan or Medicare Advantage Prescription Drug plan to help people with limited income and resources pay Part D prescription drug costs.

If you qualify for the Medicare “Extra Help” Program and get covered drugs at network pharmacies in our plan, then you will pay either your subsidized low-income copayment or your drug plan copayment (whichever is the lower amount).

If you qualify for “Extra Help,” you do not qualify for the Medicare Coverage Gap Discount Program.

If you have questions about your prescription drug costs, please review the Evidence of Coverage and contact Member Services.

Enrollment and Premium Payments

Members are able to set up payment for premiums online.

You represent and warrant that if you are setting up payments that (i) any bank account information you supply is true, correct and complete, (ii) charges incurred by you will be honored by your bank, (iii) you will pay the premiums in the amounts posted, and (iv) you are the person in whose name the account was opened and you are authorized to make a purchase or other transaction with the relevant banking information.

In order to use the online payment service, you are required to complete the enrollment process by providing Company with complete and accurate information as prompted by the applicable enrollment form provided on the enrollment screen. By completing the enrollment form, and clicking the "I Agree" button, you authorize Company to display your statement and payment information on a secure Internet site that you access. You are responsible for keeping your correct and current email address information in the Member Portal. You are entirely responsible for maintaining the confidentiality of your password, banking information, and account information.

FURTHERMORE, YOU ARE ENTIRELY RESPONSIBLE FOR ANY AND ALL ACTIVITIES THAT OCCUR UNDER YOUR ACCOUNT. YOU AGREE TO NOTIFY COMPANY IMMEDIATELY UPON YOUR DISCOVERY OF UNAUTHORIZED USE OF YOUR ACCOUNT AND ANY OTHER BREACH OF SECURITY. COMPANY WILL NOT BE RESPONSIBLE FOR ANY LOSS YOU MAY INCUR AS A RESULT OF SOMEONE ELSE MISUSING YOUR PASSWORD, BANKING INFORMATION, AND ACCOUNT EITHER WITH OR WITHOUT YOUR PERMISSION. HOWEVER, YOU COULD BE HELD LIABLE FOR LOSSES INCURRED BY COMPANY OR ANOTHER PARTY DUE TO SOMEONE ELSE USING YOUR PASSWORD. YOU MAY NOT USE ANYONE ELSE'S ACCOUNT AT ANY TIME.

Company reserves the right to change the terms and conditions of its payment processing service. You are responsible for regularly reviewing these terms and conditions. Your continued use of the payment service constitutes your agreement to all such terms.

Provider Directory

While we make efforts to ensure that our lists of doctors and hospitals (i.e., providers) are up-to-date and accurate, it is important to understand that sometimes healthcare providers leave our networks without letting us know, or they switch networks, or they change employment with provider groups and hospitals. Depending on your plan, these changes may impact how much you pay out of your own pocket for services.

Not all providers are included in every plan’s network of doctors and hospitals. In order to avoid higher costs, it is important to understand whether your provider participates in your plan’s network and if your plan’s network includes Tiered providers. If you visit a provider who is not in your plan’s network or who is a Tier 2 provider for applicable Tiered plans, you may be required to pay a greater percentage of the deductible and/or co-insurance, which is your percentage of the cost. Tiered benefit plans enable you to pay lower cost share amounts by using providers in a plan network who are assigned to benefit Tier 1 or Tier 2. Although both Tiers represent in-network providers, you will generally be responsible for lower copayments, deductibles and coinsurance. Therefore, you pay less if you use a Tier 1 provider.

If you are a member, logging in is the most accurate way to search for providers in your plan network. Your doctor may refer you to another provider or facility for treatment. In-network providers are required to make best efforts to refer you to other in-network providers when possible. However, it is important to remind your doctor to refer you to in-network providers in order to avoid out-of-network costs and additional charges from the doctor by non-participating providers, also known as balance billing.

If you receive services from an in-network hospital, the hospital may have arrangements with emergency room physicians, anesthesiologists, radiologists, and/or other providers to assist in your care. These providers may not participate in your plan’s network. To avoid out-of-network costs and balance billing by non-participating providers, when you choose a hospital in your network be sure to look for messages within the hospital’s displayed information in the search results that identifies hospital-based providers not in your plan’s network.

If your health plan has out-of-network benefits, we may reimburse you up to the maximum allowed amount for covered services if you see a non-participating provider. The process and method used by us to determine reimbursement for non-participating providers depends on your health plan. However, because we do not have a contract with non-participating providers, they can bill you for services up to their full billed charges regardless of your insurance coverage of benefits, unless prohibited from doing so by your state.

Health plans vary. We recommend that you consult your benefit plan document and/or contact the member services number listed on the back of your ID card to confirm in advance that the desired service is covered. Keep in mind that most HMO plans do not have out-of-network benefits and therefore may not reimburse for any out-of-network services except in limited circumstances (e.g., emergencies).

Medical Advice Disclaimer

The content of the Site, including without limitation, text, copy, audio, video, photographs, illustrations, graphics and other visuals, is for informational purposes only and does not constitute professional medical advice, diagnosis, treatment or recommendations of any kind. You should always seek the advice of your qualified health care professionals with any questions or concerns you may have regarding your individual needs and any medical conditions. Reliance on any information appearing on the Site, whether provided by Company, its content providers, its clients, visitors to the Site or others, is solely at your own risk.

General Warranty Disclaimer

Company does not warrant that access to, or use of the Site will not be interrupted or error-free or that defects in the Site will be corrected. This Site, including any content or information contained within it or any Site-related services, is provided "as is," with all faults, with no representations or warranties of any kind, either expressed or implied, including, but not limited to, the implied warranties of merchantability, fitness for a particular purpose, quality of information, quiet enjoyment, and title/non-infringement.

Company specifically disclaims all liability for errors or omissions in, or the misuse or misinterpretation of, any information obtained through the Site. Company does not warrant the accuracy, completeness or timeliness of the information obtained through the Site.

You assume total responsibility and risk for your use of the Site, site-related services, and linked websites. Company does not warrant that files available for download will be free of viruses, worms, Trojan Horses or other destructive programming. You are responsible for implementing procedures sufficient to satisfy your needs for data back up and security. You agree that Company shall not be liable for any cost or damage arising directly or indirectly from any such code/programming. You assume total responsibility and risk for your use of the Site and of the Internet.

Limitation of Liability Regarding Use of Site

Company and any third parties mentioned on this Site are neither responsible nor liable for any direct, indirect, incidental, consequential, special exemplary, punitive, or other damages whatsoever (including, without limitation, those resulting from lost profits, lost data, or business interruption) arising out of or relating in any way to the Site, Site-related services, content or information contained within the Site, and/or any linked website, whether based on warranty, contract, tort, or any other legal theory and whether or not advised of the possibility of such damages.

Your sole remedy for dissatisfaction with the Site, Site-related services, and/or linked websites is to stop using the Site and/or those services.

External Sites

Company makes no representations whatsoever about any other website that you may access through this Site. When you access a non-Company site, please understand that it is independent from Company, and that Company has no control over the Content on that website.
In addition, a link to a non-Company website does not mean that Company endorses or accepts any responsibility for the Content, or the use, of the linked site. It is up to you to take precautions to ensure that whatever you select for your use or download is free of such items as viruses, worms, Trojan horses, and other items of a destructive nature. If you decide to access any of the third-party sites linked to this Site, you do this entirely at your own risk.

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Online Privacy

Scope. This section describes how we use and share personal information collected through this Site. Our Site also contains links to third party sites that are not owned or controlled by Company. Please be aware that we are not responsible for the privacy practices of such other sites. We encourage you to be aware when you leave our Site and to read the privacy statements of each and every website that collects personal information.

Information You Provide to Us. You can provide information to us on our Site through various means, such as contacting us through our Site, filling out feedback forms or paying your premiums. Depending on which feature you are using, you may be asked to provide personal information such as name, address, telephone number, email address, credit or debit card information, bank account information, etc.

No Information from Children Under Age 13. If you are under the age of 13, please do not attempt to register with us at this Site or provide any personal information about yourself to us via this Site.

If we learn that we have collected personal information from a child under the age of 13, we will promptly delete that information. If you believe we might have any information from a child under the age of 13 collected via this Site, please Contact Us or call us at 734-343-1000.

Information We Collect Automatically. We collect certain information automatically as you use our Site, such as IP address, browser type, computer or device type, the website from where you navigated to our Site, and the pages on our Site that you view.

Cookies and Other Tracking Technology

We use common Internet technologies, such as cookies, tags and other tracking technology, to optimize the performance of our website and other digital properties such as social media sites, email campaigns, and online advertising.

Cookies, beacons, tags, log files and other technologies may be used to collect information about visitors to our website, use of our online services, and interactions with our email campaigns, advertisements and other marketing content. Collected information may include, but not be limited to, computer / mobile browser type, computer / mobile operating system and IP address. This data may be merged with your online interactions – pages viewed, links clicked, or content viewed. This information, and the analyses performed after collection, helps us to provide for a more customized and personalized experience for you and future visitors.

We may collaborate with advertisers and marketing research firms as part of our marketing activities. These advertisers and research firms also may use cookies and tags to track the effectiveness of marketing campaigns on our behalf. The information they collect does not contain personally identifiable information.

You can reset your browser to refuse all cookies or to indicate when a cookie is being sent. However, some website features or services may not function properly without cookies.

Please note that third parties may collect information about your internet use and visit in connection with your search and website visits.

How We Use and Share Your Information

• To Provide Products, Services, and Information. We collect personal information from you so that we can provide products and services, and information that you request from us. We use your personal information to contact you about processing of transactions, and to send Company information to you. We may provide information to third party service providers that help us bring you the services we offer. For example, we use third parties to help host and maintain our Site, and to process payments.
• Communications from Us. We respect and are committed to protecting your privacy. We may collect personally identifiable information, including your email address, when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will use the information to contact you about products, services and information and to provide relevant advertising to you. We will not sell your personally identifiable information, but we may provide your email address to third parties who will contact you about our products and services or whose products or services would be of interest to you.
• Legal Requests or Requirements and to Prevent Harm. We will share personal information with third party companies, organizations or individuals outside of Company if we have a good-faith belief that access, use, preservation or disclosure of the information is reasonably necessary to:
  • Meet any applicable law, regulation, subpoena, legal process or enforceable governmental request.
  • Enforce applicable Terms of Use, including investigation of potential violations.
  • Detect, prevent, or otherwise address fraud, security or technical issues.
  • Protect against harm to the rights, property or safety of Company, our users, customers or the public as required or permitted by law.
• Transfer in the Event of Sale or Change of Control. If the ownership of all or substantially all of our business changes or we otherwise transfer assets relating to our business or the Site to a third party, such as by merger, acquisition, bankruptcy proceeding or otherwise, we may transfer or sell your personal information to the new owner. In such a case, unless permitted otherwise by applicable law, your information would remain subject to the promises made in the applicable privacy statement unless you agree differently.