DISCOUNT SAVINGS ON DENTAL, VISION, CHIROPRACTIC, HEARING, PODIATRY, PRESCRIPTION DRUGS PHYSICIANS

WELCOME TO CAREONE BEST BENEFITS DISCOUNT MEDICAL PLAN

Please enroll my family in the CAREONE BENEFITS program initialed below:
$20.00 One Time Enrollment Fee

Membership fee $14.95 per month Membershop fee $165.00 per year

We provide the following benefits: Savings on dental, vision, chiropractic, hearing, podiatry, prescription drugs, physician care, vitamin and nutritional supplements, diabetic supplies, hospital referral program, alternative health, massage therapy,acupuncture, naturopathy, 24 hour nurse helpline and patient advocacy program. Lose weight & save up to 60% at fitness clubs nationwide and much more.

Name :_____________________________________Date:_____________

Street Address:______________________________________________

City:_______________________State:_____________Zip:___________

Phone: (______)___________

email address:_______________________

Please charge my monthly/annual payments to:

___________________Visa       __________________Mastercard

___________________Discover    _________________American Express

________________________                             _____________________
Account #                                                                  Expiration Date

Cvv code: (Last three digits on back of card) __________

Signature

Agent Name Agent #

I hereby authorize CareOne and/or MedCareRxCompare, or its designated representative to charge my bank debit card or credit card on a monthly or annual basis for the benefits I have requestd herein.

Disclaimer: This is not a health insurance policy. The plan provides discounts at certain health care providers of medical services. The 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. This plan is administered by Coverdell & Company, Inc., a discount medical plan organization at 8420 W. Bryn Mawr, Suite 700, Chicago,Il. 60631, 1 800-308-0374. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid.

Careone Benefits: 11248 S Cimarron Dr: Scottsdale, Az 85262: 877-777-4711

OFGAP2






	Click Here To Download Form WELCOME TO CAREONE BEST BENEFITS DISCOUNT MEDICAL PLAN Please enroll my family in the CAREONE BENEFITS program initialed below: $20.00 One Time Enrollment Fee Membership fee $14.95 per month Membershop fee $165.00 per year We provide the following benefits: Savings on dental, vision, chiropractic, hearing, podiatry, prescription drugs, physician care, vitamin and nutritional supplements, diabetic supplies, hospital referral program, alternative health, massage therapy,acupuncture, naturopathy, 24 hour nurse helpline and patient advocacy program. Lose weight & save up to 60% at fitness clubs nationwide and much more. Name :_____________________________________Date:_____________ Street Address:______________________________________________ City:_______________________State:_____________Zip:___________ Phone: (______)___________ email address:_______________________ Please charge my monthly/annual payments to: ___________________Visa __________________Mastercard ___________________Discover _________________American Express ________________________ _____________________ Account # Expiration Date Cvv code: (Last three digits on back of card) __________ Signature Agent Name Agent # I hereby authorize CareOne and/or MedCareRxCompare, or its designated representative to charge my bank debit card or credit card on a monthly or annual basis for the benefits I have requestd herein. Disclaimer: This is not a health insurance policy. The plan provides discounts at certain health care providers of medical services. The 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. This plan is administered by Coverdell & Company, Inc., a discount medical plan organization at 8420 W. Bryn Mawr, Suite 700, Chicago,Il. 60631, 1 800-308-0374. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid. Careone Benefits: 11248 S Cimarron Dr: Scottsdale, Az 85262: 877-777-4711 OFGAP2