Group Legion Limited Benefit Medical

Limited Benefit Medical Plan underwritten by: AXIS Insurance Company

Plans are not available in all states and are provided through a membership in the Alliance For Consumers
USA (ACUSA)

Insurance coverage is underwritten by AXIS Insurance Company. Coverage is subject to exclusions and
limitations, and may not be available in all US states and jurisdictions. Product availability and plan design
features, including eligibility requirements, descriptions of benefits, exclusions or limitations may vary
depending on local country or US state laws. Full terms and conditions of coverage, including effective dates
of coverage, benefits, limitations, and exclusions
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Underwritten by Association Billing and Customer Service

AXIS Insurance Company

THIS INSURANCE PROVIDES LIMITED BENEFITS. LIMITED BENEFIT PLANS ARE INSURANCE PRODUCTS WITH REDUCED BENEFITS AND ARE NOT INTENDED
TO BE AN ALTERNATIVE TO OR INTEGRATED WITH COMPREHENSIVE COVERAGE. FURTHER, THIS INSURANCE DOES NOT COORDINATE WITH ANY OTHER
INSURANCE PLAN. IT DOES NOT PROVIDE MAJOR MEDICAL OR COMPREHENSIVE MEDICAL COVERAGE AND IS NOT DESIGNED TO REPLACE MAJOR MEDICAL
INSURANCE. FURTHER, THIS INSURANCE IS NOT MINIMUM ESSENTIAL BENEFITS AS SET FORTH UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE ADDITIONAL PAYMENT WITH YOUR TAXES.

COVERAGE IS SUBJECT TO EXCLUSIONS AND LIMITATIONS, AND MAY NOT BE AVAILABLE IN ALL US STATES AND JURISDICTIONS. PRODUCT AVAILABILITY
AND PLAN DESIGN FEATURES, INCLUDING ELIGIBILITY REQUIREMENTS, DESCRIPTIONS OF BENEFITS, EXCLUSIONS OR LIMITATION MAY VARY DEPENDING ON
LOCAL COUNTRY OR US STATE LAWS. FULL TERMS AND CONDITIONS OF COVERAGE, INCLUDING EFFECTIVE DATES OF COVERAGE, BENEFITS, LIMITATIONS
AND EXCLUSIONS, ARE SET FORTH IN THE POLICY.
© All rights reserved. Health Plan Intermediaries Holdings, LLC, 2019
Plan Benefits
The below benefits are not available in Connecticut and New Jersey.

This is a brief summary of Legion Limited Benefit Medical Plan. Benefits are subject to the policy limitations and
exclusions. Refer to the policy, certificate, and riders for complete details.

Plan 1 Plan 2 Plan 3 Plan 4

Daily Hospital Confinement $100 per day x 30 days $500 per day x 30 days $1,000 per day x 30 days $1,000 per day x 30 days
ICU (5 days) None $500 per day x 5 days $750 per day x 5 days $750 per day x 5 days
Office Visits $50 per day x 3 days $100 per day x 3 days $100 per day x 5 days $50 per day x 5 days
Wellness Benefits $50 per day x 1 day $50 per day x 1 day $50 per day x 2 days $50 per day x 2 days
Wellness Baby Benefits None $50 per day x 1 day $50 per day x 2 days $50 per day x 2 days
ER (Covered Sickness Only) None $100 per day x 2 days $250 per day x 2 days $500 per day x 2 days
Inpatient Surgery None $500 per day x 2 days $1,000 per day x 2 days $1,500 per day x 2 days
25% of the Benefit Amount 25% of the Benefit Amount 25% of the Benefit Amount
Inpatient Anesthesia None
for Inpatient Surgery for Inpatient Surgery for Inpatient Surgery
$1,500 per day x 1 day
(first surgery)
Outpatient Surgery None $500 per day x 1 day $1,000 per day x 1 day
$1,000 per day x 1 day
(second surgery)

25% of the Benefit Amount 25% of the Benefit Amount 25% of the Benefit Amount
Outpatient Anesthesia None for Outpatient Surgery for Outpatient Surgery for Outpatient Surgery

Diagnostic, X-ray and Laboratory

Class 1: Laboratory – Bloodwork,

CMP, Lipid Panel, ECG, Pap/PSA,
urinalysis and all other laboratory
tests Maximum number of days
$25 per day x 2 days $50 per day x 2 days $35 per day x 3 days $50 per day x 3 days
for laboratory tests including blood
work, comprehensive metabolic
panel, lipid panel, all other lab
per Plan Year

Class II: Radiology, Ultrasound,

Mammogram, Sonogram, None $50 per day x 2 days $50 day x 4 days $50 day x 4 days
Angiogram

Class III: Imaging CT, PET None None None None

Class IV: Other Diagnostic tests-

Endoscopy, Bronchoscopy, None $50 per day x 1 day $100 per day x 2 days $100 per day x 2 days
Colonoscopy without Biopsy, MRI

Product Summary
Waiting Period No waiting period for accidental injuries or sickness
Eligibility Ages 18 - 64
Network First Health Network*
*THE FIRST HEALTH NETWORK IS A DISCOUNT PROGRAM PROVIDING ADDITIONAL DISCOUNTED SAVINGS WHEN PARTICIPATING PROVIDERS AND
FACILITIES ARE USED FOR MEDICAL SERVICES. THIS IS NOT INSURANCE. ANY FIRST HEALTH DISCOUNT APPLIED TO MEDICAL SERVICE IS IN ADDITION
TO YOUR INSURANCE COVERAGE WHICH PAYS A SEPARATE FIXED INDEMNITY BENEFIT DIRECTLY TO YOU FOR COVERED MEDICAL SERVICES. THIS IS NOT
INSURANCE AND IS NOT PROVIDED BY AXIS INSURANCE COMPANY.
Insurance coverage is underwritten by AXIS Insurance Company. Coverage is subject to exclusions and limitations, and may not be available in all US states and
jurisdictions. The group insurance policy is held by Alliance for Consumers USA, Inc., in Nebraska, under policy form # T-GHI-001-0112-NE. Product availability and
plan design features, including eligibility requirements, descriptions of benefits, exclusions or limitations may vary depending on local country or US state laws. Full
terms conditions of coverage, including effective dates of coverage, benefits, limitations, and exclusions, are set forth in the policy.
THIS INSURANCE PROVIDES LIMITED BENEFITS. LIMITED BENEFITS PLANS ARE INSURANCE PRODUCTS WITH REDUCED BENEFITS AND ARE NOT
INTENDED TO BE AN ALTERNATIVE TO OR INTEGRATED WITH COMPREHENSIVE COVERAGE. FURTHER, THIS INSURANCE DOES NOT COORDINATE
WITH ANY OTHER INSURANCE PLAN. IT DOES NOT PROVIDE MAJOR MEDICAL OR COMPREHENSIVE MEDICAL COVERAGE AND IS NOT DESIGNED
TO REPLACE MAJOR MEDICAL INSURANCE. FURTHER, THIS INSURANCE IS NOT MINIMUM ESSENTIAL BENEFITS AS SET FORTH UNDER THE PATIENT
PROTECTION AND AFFORDABLE CARE ACT. IF YOU DON’T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE ADDITIONAL PAYMENT WITH
YOUR TAXES.
Exclusions and Limitations
Benefits in connection with a Pre-existing Conditions occurring
within the first twelve (12) months of coverage are not payable.
“Pre-existing Condition” means an illness, disease, or other
condition of the Covered Person, that was treated, diagnosed
or required medications in the six (6) month period before the
Covered Person’s coverage became effective under this Policy.
This Pre-Existing Condition Limitation shall not apply after the
end of the Limitation Period shown in the Schedule of Benefits,
commencing on the Insured Person’s Coverage Effective Date.
In addition to any benefit or coverage specific exclusion, benefits
will not be paid for any loss which directly or indirectly, in whole
or in part, is caused by or results from any of the following unless
coverage is specifically provided for by name in the Description
of Benefits section of the insurance certificate:
1. Intentionally self-inflicted injury, suicide or any attempt
while sane or insane;
2. ILLEGAL OCCUPATION: The insurer shall not be liable for
any loss to which a contributing cause was the insured’s
commission of or attempt to commit a felony or to which
a contributing cause was the insured’s being engaged in an
illegal occupation.
3. Declared or undeclared war or act of war;
4. Release, whether or not accidental, or by any person
unlawfully or intentionally, of nuclear energy or radiation,
including sickness or disease resulting from such release;
5. An injury or sickness that occurs while on active duty
service in the military, naval or air force of any country or
international organization. Upon Our receipt of proof of
service, the Company will refund any premium paid for this
time. Reserve or National Guard active duty training is not
excluded unless it extends beyond 31 days;
6. Travel or activity outside the United States, Canada or
Mexico, except for a Medical Emergency;
7. Flight in, boarding or alighting from an Aircraft except as: a
fare-paying passenger on a regularly scheduled commercial
or charter airline; a passenger in a non-scheduled, private
Aircraft used for pleasure purposes with no commercial
intent during the flight;
8. Travel in any Aircraft owned, leased or controlled by
the Policy holder, or any of its subsidiaries or affiliates.
An Aircraft will be deemed to be “controlled” by the
Policyholder if the Aircraft may be used as the Policy holder
wishes for more than 10 straight days, or more than 15 days
in any year;
9. Bungee-cord jumping, parachuting, skydiving, parasailing,
hang-gliding;
10. Voluntary ingestion of any narcotic, drug, poison, gas or
fumes, unless prescribed or taken under the direction of
a Physician and taken in accordance with the prescribed
dosage;
11. The Insured Person’s intoxication. The Insured Person is
conclusively deemed to be intoxicated if the level in his
blood exceeds the amount at which a person is presumed,
under the law of the locale in which the accident occurred,
to be under the influence of alcohol if operating a motor
vehicle, regardless of whether he is in fact operating a motor
vehicle, when the injury occurs. An autopsy report from a
licensed medical examiner, law enforcement officer’s report,
or similar items will be considered proof of the Insured
Person’s intoxication;
12. An Accident if the Insured Person is the operator of a motor
vehicle and does not possess a valid motor vehicle operator’s
license, unless: (a) the Insured Person holds a valid learners
permit and (b) the Insured Person is receiving instruction
from a driver’s education instructor;
13. Alcoholism, drug addiction or the use of any illegal drug
or narcotic except as prescribed by a Physician unless
specifically provided herein;
14. Repair or replacement of existing dentures, partial dentures,
braces, fixed or removable bridges, or other artificial dental
restoration;
15. Repair, replacement, examinations for prescriptions or the
fitting of eyeglasses or contact lenses.
16. Elective Abortion. Elective Abortion means an abortion for
any reason other than to preserve the life of the female upon
whom the abortion is performed.
17. Mental and nervous disorders.
18. Elective surgery or cosmetic surgery, except for
reconstructive surgery needed as the result of a Covered
Injury or Covered Sickness.
19. Experimental or Investigational drugs, services, supplies.
For the purposes of this exclusion, “Experimental or
Investigational” means medical services, supplies or
treatments provided or performed in a special setting for
research purposes, under a treatment protocol or as part of
a clinical trial (Phase I, II or III). The covered service will also
be considered Experimental or Investigational if the Insured
Person is required to sign a consent form that indicates
the proposed treatment or procedure is part of a scientific
study or medical research to determine its effectiveness or
safety. Medical treatment, that is not considered standard
treatment by the majority of the medical community
Exclusions and Limitations (continued)
or by Medicare, Medicaid or any other government
financed programs or the National Cancer Institute
regarding malignancies, will be considered Experimental
or Investigational. A drug, device or biological product is
considered Experimental or Investigational if it does not
have FDA approval or approval under an interim step in the
FDA process, i.e., an investigational device exemption or an
investigational new drug exemption.
20. Treatment for being overweight, gastric bypass or stapling,
intestinal bypass, and any related procedures, including
complications.
21. Sexual reassignment surgery, sexual transformation
surgery, sexual transgendering surgery.
22. Services related to sterilization, reversal of a vasectomy or
tubal ligation; in vitro fertilization and diagnostic treatment
of infertility or other problems related to the inability to
conceive a child, unless such infertility is a result of a
Covered Injury or Covered Sickness.
23. Treatment or services provided by a private duty nurse.
24. Organ or tissue transplants and related services.
25. Personal comfort or convenience items.
26. Rest or custodial cures.
27. Hearing aids.
28. An Injury or Sickness for which the Insured Person is paid
benefits under any Workers’ Compensation or occupational
disease law or under any insurance policy that provides
benefits to the Insured Person for injuries resulting from an
occupational accident.
In addition, benefits will not be paid for services or treatment
rendered by any person who is:
1. Employed or retained by the Policyholder;
2. Living in the Insured Person’s household;
3. An Immediate Family Member of either the Insured
Person or the Insured Person’s Spouse;
4. The Insured Person.

Disclaimer: Exclusions and limitations vary by state. REFER TO YOUR CERTIFICATE for terms and conditions of coverage, including effective dates of coverage, benefits,
limitations, and exclusions.
Network

First Health*
The First Health Network is one of the nation’s largest PPO networks, offering access to quality, affordable
healthcare. First Health Network has access to more than 5,000 hospitals, over 90,000 ancillary facilities, and over 1
million health care professional service locations in the United States, including Puerto Rico. The network covers over
98% of the U.S. population.

Your membership card will feature the network participating providers and can be searched 24 hours a day
here:  http://www.firsthealthlbp.com.

Members should present their ID card each time they seek services from a participating provider to ensure they
receive the full value of the First Health Network.

Disclaimer: *The First Health Network is a discount program providing additional discounted savings when participating providers and facilities are used for medical
services. This is not insurance. Any First Health discount applied to medical service is in addition to your insurance coverage which pays a separate fixed indemnity
benefit directly to you for covered medical services. This is not insurance and is not provided by AXIS Insurance Company.
Your exclusive membership in the

The mission of Alliance For Consumers USA, is to serve, support, represent and promote the interests of its members; to provide
educational programs, research, instruction, training and other information to the corporation’s members for the purpose of en-
hancing consumer awareness in areas related to economics, finance, health and wellness, social, environmental and other human
issues; to provide access to appropriate benefits, products and services needed and desired by its members on a cooperative,
cost efficient and economical basis.
Besides this insurance plan, ACUSA provides access to great discounts such as:

Costco Membership Griswold® Home Care Elder Care

With your ACUSA membership, you will receive access to a
Costco membership as well as exclusive coupons for savings and free
products. You’ll quickly discover why 87 million people are Costco
members and receive coupons for free products exclusive to ACUSA
members.
Identity Guard
In today’s digital world, our identities are comprised on many levels
every day, including our social media profiles, pictures of family, and
GPS locations. You will have access to an exclusive discounted rate
for Identity Guard, a service with monitoring products that provide
the most complete view exposure of their personal information.
LegalEASE
When a legal problem arises, you need immediate attention
and the right choices to solve the problem as quickly as possible.
LegalEASE’s “we-do-it-for-you” attitude gives you the security to
know you have help behind you when facing your legal problems. At-
torney fees for legal needs are either 100% paid-in-full, partially paid,
or offered at a discounted hourly rate when you work with a network
attorney.
Long-Term Care Resources
As a leader in the long-term care insurance industry for almost 20
years, Long-Term Care Resources (LTCR) can offer you access to qual-
ity insurance as well as a wide choice of carriers, products (traditional
and hybrid), and underwriting criteria.
From referrals for options on such issues as senior living, VA benefits,
hospice care, and more to determining appropriate home care ser-
vices, Griswold® Home Care Elder Care can connect you with
professionals who can provide much needed resources and advice.
Needy Meds
This nationwide nonprofit is a free service that helps you to identify
programs to alleviate the cost of your prescriptions and healthcare.
It also provides you with a prescription discount card that allows
savings up to 80% off cash prices.
DirectLabs®
You can take charge of your health and fitness with direct access to
major clinical labs for critical tests at discounted prices. The earlier
medical conditions are detected, the easier and more likely they are to
be treatable.
ACI Specialty Benefits Member Assistance Program
Through ACI’s nationwide network of clinicians, life coaches, and
work/life specialists, you and your family can receive comprehensive,
personalized support for issues affecting emotional well-being via
telephone or video chat sessions.
DreamVacations.com
You can take advantage of access to exclusive offers for full service
travel and can earn spending credits toward shore and land excur-
sions, airfare, and spa services through this membership benefit.

MetLife
You can enjoy access to special discounts for auto and home cov-
erage as well as take advantage of group discounts and exclusive
valuable features and benefits.

Disclaimer: ACUSA benefits described on this page are not insurance and are not provided
by AXIS Insurance Company.
Heighten Care
Dear New Member:
The National Congress of Employers (NCE) is pleased to
welcome you to its Dentachoice Discount Savings Program! As
part of NCE’s greater effort to improve the lives of our members,
we have contracted with several providers to create the NCE
Dentachoice Discount Savings Program.
The Program consists of:
NCE DentaChoice
This program utilizes the Aetna Dental Access® network. It is
designed to help minimize dental care expenses with an average
savings of 15-50% per visit on services such as cleanings,
x-rays, fillings, root canals, and crowns as well as specialty care
such as orthodontics and periodontics where available. Dentists
who participate in the Aetna Dental Access® network have
agreed to accept discounted contract rates as payment-in-full
for services performed. The program has no exclusions for pre-
existing conditions, no benefit maximum, no waiting period, and
requires no referrals to see a specialist. Additionally, as a
member of the NCE you will receive discounts on Vision.
NCE Discount Prescription Drug Card
This program saves an average of 15% on brand name and 55%
on generic medications. Accepted at over 80% of pharmacies in
the US and its territories, including Puerto Rico, anyone in your
family can use the card, regardless of age.
NCE Brand-Name Mail Order Program
This program saves up to 80% on your brand-name
medications through our international mail order program.
Ordering your discount brand-name medications is convenient,
easy, and secure. Your medications will ship directly to you!
Pet Rx Savings
Save on your pets’ medications with your script from the vet
when purchasing pet medications at your local pharmacy if
it’s derived from a human medication or online for a pet-only
medication.
Patient Assistance Program
If you still need assistance with your prescription costs and
you meet the income guidelines, you can receive low cost
prescription medicine after a qualification process.
CBD Products
Receive high-quality, broad spectrum CBD products that are a
natural and effective alternative towards health and healing for
you and your pets.
Speech Therapy Savings
Your convenient and personal online solution to traditional
Speech Therapy, utilizing video conferencing technology to
provide live, one-on-one, highly individualized and interactive
speech therapy services worldwide.
Included in the following pages of this mailing, you will find your
NCE Dentachoice Discount Program fulfillment kit, including
your ID cards. Please take time to review these materials
carefully.
For any questions regarding your billing please call Member
Services at 1-844-792-6985.
Thank you, and congratulations on joining the NCE!
 Dear New Member:

Below are your ID cards for the NCE Dentachoice program.

To access a list of participating providers and locations or to

obtain additional information regarding all your benefits, please
visit www.ncedentachoice.com.

Save up to 80% on your brand-name medications through our

international mail order program. Ordering your discount brand-
name medications is convenient, easy, and secure. Visit

www.medaffordglobal.com/nce4026 to price your

medications and begin your order. Your medications will ship
directly to you.

AO-NCEBID.715 THIS PROGRAM IS NOT INSURANCE. IT IS A DISCOUNT PROGRAM.

 TERMS AND CONDITIONS

Savings indicated herein are based on providers’ usual and customary fees. Discounts outlined herein cannot be used
with any other discount plan or promotion. Prices charged by vendors may be adjusted from time to time without notice
to the cardholder. Occasionally, certain vision providers may offer products or services to the general public at prices
lower than our prices. In such an event, the member will be charged the lower price. This is a discount program, not
insurance, and may be discontinued or modified at any time. AccessOne Consumer Health, Inc. (administrator) or

National Benefit Builders, Inc. (NBBI) are not licensed insurers, HMOs or underwriters of healthcare services. No portion
of any providers’ fee will be reimbursed or otherwise paid to a participating member by AccessOne Consumer Health,
Inc. or National Benefit Builders, Inc. (NBBI)

Providers in the program are solely responsible for the professional advice and treatment rendered to members.
AccessOne Consumer Health, Inc. and National Benefit Builders, Inc. (NBBI) disclaim any liability with respect to such
matters. AccessOne Consumer Health, Inc. and NBBI reserve the right to replace any network and will notify members
accordingly. Discounts on professional services are not available where prohibited by law. For complaints, contact
AccessOne Consumer Health Inc at 84 Villa Road, Greenville, SC 29615 or at the website

www.accessonedmpo.com.

The Dentachoice Dental and Vision Program provides access to the Aetna Dental Access® network, which is
administered by Aetna Life Insurance Company (ALIC). ALIC does not offer or administer the Dentachoice Dental and
Vision Program, and is not an affiliate, agent or principal of Dentachoice Dental and Vision Program. Dental providers are
independent c IC. ALIC does not provide dental care and is not responsible for outcomes.

AO-NCEBID.715 THIS PROGRAM IS NOT INSURANCE. IT IS A DISCOUNT PROGRAM.

MEMBERSHIP PARTICIPATION AGREEMENT

As a member of Dentachoice Discount Dental and Vision Program, referred hereafter as the “Plan”, you are a
participant in a Discount Medical Plan Organization provided by AccessOne Consumer Health, Inc. Below are
the terms and conditions of your membership in the discount medical plan. This agreement is between you
and AccessOne.

The effective date of your enrollment is as of the date you receive your card.

La. R.S. 22:1260.7.D(1)(d) - The mode of payment of any processing fees and periodic charges and procedure
for changing the mode of payment.

DISCLOSURES:
• The Plan is not insurance;
• The Plan provides discounts at certain healthcare providers for medical services;
• The Plan does not make payments directly to the providers of medical services;
• The Plan member is obligated to pay for all healthcare services but will receive a discount from
healthcare providers who have contracted with the discount Plan organization;
• The name and address of the licensed discount medical Plan organization: Access One Consumer
Health, Inc., 84 Villa Road, Greenville, SC 29615; (800)896-1962;
www.accessonedmpo.com.

You may find a list of participating providers at: www.ncedentachoice.com or you may call toll free
(888) 311-6224. You will be able to apply Plan discounts to all participating providers.

All Plan members receive discounts at participating dental and vision providers. You will receive savings
ranging from 15-50% per visit on included services. You may go to www.ncedentachoice.com for a list of
providers available by zip code.

At participating providers, you will be billed at the time of service and the applicable discount(s) will be
applied to that bill. In no instance will the Plan make payments to the provider on your behalf.

Your participation in the Plan will continue monthly or annually upon timely payment of your monthly or
annual dues and shall cease upon your failure to make the payment. You may terminate your participation in
the Plan by returning your ID card to

Dentachoice/NBBI, 25 Hanover Road, Suite A-200, Florham Park, NJ 07932. If you return your card at any
time within the first 30 days of receipt, you will be refunded the entire membership fee, less the one-time
registration fee, if any.

This plan includes, as per application, you and your legal dependents at no additional charge. You are not
required to list your dependents for them to participate in the Plan.

If you have a complaint regarding the Plan, you may contact Dentachoice at: www.ncedentahcoice.com and
(888) 311-6224 or, in writing to: NBBI, 25A Hanover Road, Florham Park, NJ 07932. The complaint will be
addressed and you will receive a response within 15 business days.

This Member Agreement AO-DACMPA2013, the Member ID Card AO-DACID2013 and its Benefit
Descriptions represent the entire agreement between you and AccessOne Consumer Health, Inc. and
supersedes all other prior representations, statements, or written agreements between you and AccessOne.
AccessOne Consumer Health, Inc. has no liability for providing nor guaranteeing service or any liability for the
quality of services rendered.

AO-NCEBID.715 THIS PROGRAM IS NOT INSURANCE. IT IS A DISCOUNT PROGRAM.

Maryland Residents: The membership fee and one-time registration fee (minus $5.00) will be refunded if
cancelled within the first 30 days and upon return of the discount card.

Massachusetts Residents: The Plan is not insurance coverage and does not meet the minimum creditable
coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. 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.

Nebraska Residents: If you have cancelled at any time after the 30 day period, and you have pre-paid any
membership fees, the prepayment will be refunded on a pro-rata basis for months you have not used.

Texas Residents: If you are paying for the discount medical Plan, AccessOne or the Plan will cease collecting
membership fees in a reasonable amount of time, but no later than (30) days after receiving a valid
cancellation notice. This Plan is: regulated by the Texas Department of Insurance, P.O. Box 12157 Austin Texas
78711: telephone 1-800-252-3439 or (512) 463-6515; website:

www.tdi.state.texas.com.

West Virginia Residents: If after receiving our response and you are not satisfied with the resolution you may
write of call: West Virginia Insurance Commissioner.

Renewal Conditions: By joining the plan, you are authorizing NBBI to bill your credit card or checking account.
This charge shall remain in force until you notify NBBI in writing of its cancellation. This plan will automatically
renew (monthly or annually) until cancelled.

AO-NCEBID.715 THIS PROGRAM IS NOT INSURANCE. IT IS A DISCOUNT PROGRAM.

 How It Works

Step 1. Price your brand-name medication.

NCE Dentachoice Plus
Step 2. Complete your order online or Call 855-633-7977 to
place your order.

Step 3. Your medications ship directly to you.

Commonly ordered brand-name medications

Abilify Cymbalta Pradaxa

Advair Diskus Entocort Premarin

Celebrex Januvia Viagra

Cialis Lyrica Vytorin

Crestor Nexium Xarelto

AO-DACAD3 v2018 © 2018 National Benefit Builders, Inc.

Walk-in Pharmacy
The NCE Dentachoice Plus Program provides access to the Aetna Dental Access®
network. This network is offered by Aetna . Life Insurance Company (ALIC). Receive discounts up to 85%, with average savings of 15% on
Neither ALIC nor any of its affiliates offers or administers the Dentachoice Dental brand-name and 55% on generic drugs.
and Vision Program. Neither ALIC nor any of its affiliates is an affiliate, agent,
representative or employee of National Benefit Builders, Inc. (NBBI). Dental Highlights of the discount card
providers are independent contractors and not employees or agents of ALIC or its
affiliates. ALIC does not provide dental care or treatment and is not responsible • Our discount drug card has saved our
for outcomes. cardholders over $1 billion.
• Card is pre-activated and never expires.
This program is not insurance. • Use the card immediately.
It is a discount program. • Covers entire household, with no exclusions.
• Personal information is never collected from
the card user.

Discount Prescription
How does it work?

Brand-Name Mail Order
Save up to 80% on your brand-name medications through
our international mail order program. Ordering your discount
brand-name medications is convenient, easy, and secure.
With a valid prescription from your doctor our Customer Service
team will assist you in identifying savings on your brand drug(s)
and provide information on cost differential by dosage and
country, order your prescription, and set you up for refill reminder.
Present your prescription drug discount card to your pharmacy.
When the card information is entered into the pharmacy’s
system, the price on the prescription is discounted based on
the pharmacy’s agreement with our program.
The discount prescription cards are accepted at over 80% of
pharmacies in the US and its territories, including Puerto Rico.
Anyone can use the prescription drug discount card, regardless
of age or income. Our discount prescription card can allow
someone to fill a prescription when they may normally go
without.
 Dental

This discount program utilizes the Aetna Dental Access network providing you access to over 248,000 available dental practice
locations. Savings range from 15 – 50% per visit on dental procedures including check-ups, cleanings, fillings, and root canals.
Orthodontics, teeth whitening, cosmetic dentistry, oral surgery, and children’s specialists are also included.

Vision

Our discount vision program utlizes Outlook Vision and offers you average discounts of 10-50% at over 12,000 optical centers,
whether they are major chains or independent eye care centers. Discounts can be received on eyeglasses (frames and lenses),
prescription sunglasses, contact lenses and corrective surgery.

Additional benefits include:

• Prescription Savings • CBD Products
• Pet Prescription Savings • Speech Therapy Savings
• Patient Assistance Program

Sample Dental Care Savings:

Select regional average Average cost with
Your total savings
cost by Aetna® * Dentachoice
Periodic Oral Exam $70 $35 $35
Comprehensive Oral Exam $180 $50 $58
X-Ray, Intraoral - Complete Series Including $163 $87 $76
Bitewing
Cleaning (Prophylaxis) - Adult $124 $67 $57
Cleaning (Prophylaxis) - Child $91 $51 $40
Filling - 1 Surface Resin (White) Filling, Front $200 $101 $99
(Anterior) Toot
Crown - Porcelain Fused to High Noble $1,278 $825 $453
Metal (i.e. gold)
Root Canal Molar, Excluding Final Resto- $1,189 $851 $338
ration
Extraction of Erupted Tooth or Exposed Root
- Includes Local Anesthesia and Suturing If $219 $99 $120
Needed
Comprehensive Orthodontic Treatment
$5,991 $3,549 $2,442
Child

Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from
participating providers to determine the average costs, as shown on the chart. * The select regional average cost represents the
average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of care
tool as of September 2017.
 Sample Vision Care Savings:
Member
Location Item Retail Savings - %
price 2
$129.00 $90.30 $38.70 – 30%
Exact Eye Care Kearney, NE Frame Single Vision w/ Polycarbonate $297.00 $207.90 $89.10 – 30%
$149.95 $104.96 $44.99 – 30%
LensCrafters Mesa, AZ Frame Single Vision w/ Photo Flextint $225.00 $157.58 $67.50 – 30%
$229.95 $149.47 $79.98 – 35%
Frame Single Vision w/ Polycarbonate
JC Penney Michigan $208.00 $100.00 $108.00 – 52%
& AR Contact Lenses $90.00 $72.00 $18.00 – 20%
$59.95 $30.00 $29.95 – 50%
Pearle Vision National City, CA Frame Single Vision w/ Scratch Coat $109.00 $55.00 $54.00 – 50%
$99.95 $69.96 $29.99 – 30%
EyeMaster Henderson, NV Frame Single Vision w/ Polycarbonate $149.98 $104.99 $44.99 – 30%

2 Actual costs and savings vary by provider and geographic area. Disclaimer: Prices can change without notice.

This is not insurance. This does not meet the requirements of the PPACA. You must pay for services at the time they are rendered. If
you use a participating dentist you will receive a discount. Neither Dentachoice, Aetna, NBBI or the DMPO will pay for any services
received. You may contact the Discount Medical Plan Organization at AccessOne Consumer Health, Inc. 84 Villa Rd. Greenville SC
29615 www.accessonedmpo.com. This program is not available in Alaska, Montana, Rhode Island, Utah, Vermont and Washington.

AO-DACAD3 v2018