Careington 500 Dental
(NOT the reduced discount "CI" Series Plan!)
EyeMed Vision
CLCA Chiropractic
Premiums are: $6.85 PER MONTH for an individual applicant, $8.85 PER MONTH for an applicant plus one family member,
or $11.95 PER MONTH for your entire family. 9% Discount for Annual Premium!
A family membership covers all persons in your household, regardless of actual relationship. To be eligible, all persons listed on the application must be permanent residents of the address listed on the application.
There is a one-time registration fee of $15 for the Plan. This fee is refundable within the first thirty days.
Please complete the application TODAY so that we may process your request immediately. Plan benefits will begin on the 1st day of the month following receipt of your application.
If you require dental services prior to the 1st day of next month, we can, upon request (see form below), put your coverage into effect within 2 business days.
(If you have a dental or chiropractic emergency, do not delay treatment. Such a delay could result serious harm or illness, and might result in expenses that exceed any savings realized by waiting for coverage to go into effect.)
Once you have completed the application below, we will send you an email message as your confirmation of receipt of your application. The confirmation will contain instructions and telephone numbers that will allow you to make your first appointment without ID cards (they will arrive in 2-3 weeks).
CIADental uses a true Secure Application system powered by Plug'n Pay Technologies to assure the confidentiality of your personal information. However, if you are uncomfortable using the internet for transactions, we can take your application over the phone. Please call us M-F, at 847-483-9484, between 9:00 am and 5:00 pm Central Time.
If you prefer, click
HERE to complete a printable form that you can fax or mail in.
READ
CAREFULLY BEFORE YOU APPLY
Member Information Guide
and Membership Identification Card(s) will be supplied via U.S. Postal
service. Your
request authorizes Comprehensive Insurance Agency, LLC to charge your credit card or debit your checking account
for the initial and subsequent payments to start and continue your
POSCard membership. Comprehensive Insurance Agency, LLC will charge your
credit card or debit your checking account as each modal premium payment comes due. You must provide
Comprehensive Insurance Agency, LLC 30 days written notice if you wish to cancel
your POSCard membership.
ENROLLMENT FEE
A one time, non-recurring enrollment fee of $15.00 will be added to the
first modal premium charge that appears on your credit card statement.
Your TOTAL INITIAL PAYMENT CHARGE will be your chosen
plan premium PLUS $15.00.
All premiums thereafter will be the chosen modal premium.
I
understand that my coverage will not become effective, active and available
until the 1st day of the 1st month following submission of my application
unless the "Earliest Available" option was chosen on the application.
I understand that if I have chosen the "Earliest Available" option,
my plan benefits will become available to me 3 business days after receipt of
my application by Comprehensive Insurance Agency, LLC, that my credit card or checking account
will be billed
for a full month regardless of the number of days remaining in the month at the
time benefits become available, and that I am not eligible for any benefits,
retroactive or otherwise, prior to the actual activation date, regardless of
the effective date used for billing purposes.
AGREEMENT AND AUTHORIZATION
I have read, understand
and agree to the terms and conditions above. I authorize Comprehensive
Insurance Agency, LLC to sign and charge my credit card or debit my
checking account according to the plan and paymentfrequency I have chosen.
I authorize Comprehensive Insurance Agency, LLC
the authority to charge my credit card or debit my checking account for all future modal
renewal premiums as they come due. I will notify Comprehensive Insurance Agency, LLC
in writing of my wish to cancel my POSCard membership at least 30 days
in advance.
Exclusions:
Specific procedures begun prior to the earlier of the application date or
effective date are not covered.
Procedures performed by a non-network providers are not covered.
You must verify that the provider is in the network when scheduling your
appointment.
