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| Disclosures for Liberty
Dental Vision Plan: |
| This is NOT insurance. |
| Discount Medical Plan Organization:
New Benefits Limited, 14240 Proton Rd. Dallas, TX 75244 |
| Telephone number of Discount
Mediacal Plan Organization: 800-800-7617 |
| Internet website address
to obtain participating providers: www.libertymembers.com. |
| This discount card program contains
a 30 day cancellation period. |
| MD, ND, OK, SC, SD, and
TX residents: Member shall receive a full refund of membership fees, excluding
registration fee, if membership is cancelled within the first 30 days after
receipt of membership materials. |
| AR and TN residents: A refund of all fees will be issued
if membership is cancelled within the first 30 days. |
| This plan provides discounts at certain
health care providers for medical services. |
| This plan does not make payments directly
to the providers of medical services. |
| The plan member is obligated to pay for
all health care services but will receive a discount from those health
care providers who have contracted with the discount plan organization. |
| The range of discounts for medical or
ancillary services provided under the plan will vary depending on the type
of provider and medical or ancillary service received. |
| The discount medical card program makes
available, before purchase and upon request, a list of program providers,
including the name, city, state, and specialty of each program provider
located in the cardholder's service area. |
