Terms & Conditions

Annual Rebate Program

"Covered" offers a rebate to all members that will be issued once per calendar. Members that contribute membership fees totaling more than the amount that they were reimbursed for healthcare costs during the calendar year are eligible for the rebate. The amount that the member will be eligible for will be up to the difference of the amount in membership fees that were paid in during the calendar year minus the amount that they were reimbursed for their healthcare costs during the same calendar year until available rebate funds are exhausted. The amount of funds available for use in the rebate program will be calculated using the average monthly healthcare cost of all members for the calendar year, leaving enough funds in the group shared account to remain solvent. The amount of funds available for use in the rebate program may vary annually. Due to the variance in available funds in the rebate program, no rebate amount is guaranteed.

Terms & Conditions - the basics

Member eligibility: "Covered" is not an insurance company. It is a club that is voluntarily opted into. "Covered" is currently accepting generally healthy 20 to 50 year old individuals. Current health conditions will be reviewed by the membership eligibility team to determine membership acceptance. If the cost of treatment for current and/or ongoing health conditions is determined by "Covered" to outweigh the amount of monthly contributions made by the applicant they may be deemed as a non-contributory member and acceptance may be declined. Any moneys paid for the initial enrollment will be fully refunded to the applicant should initial acceptance be declined.

New applicants may apply at any time during the calendar year. Each member will contribute $250 by or on the 1st of each calendar month (unless a discounted rate has otherwise been offered) for health care cost reimbursement requests to be made available for the same calendar month. Upon approval of a new application, group funds to reimburse members for medical expenses will become available for request on the 1st of the next calendar month. If the full monthly membership fee has not been received on the 1st day of the calendar month, access to reimbursement for healthcare costs will not be made available to the club member until the monthly membership fee has been paid in full. Upon submission of each new membership application, the member agrees that "Covered" may access PHI (protected health information) and/or health records in order to determine eligibility and/or healthcare cost reimbursement eligibility. Members will voluntarily provide requested healthcare records to "Covered" via secure, HIPAA compliant email or fax. Failure to provide requested documents may result in termination of membership or denial or reimbursement requests made by the member. Health records may only be used by "Covered" to determine membership eligibility and/or determination of reimbursement for healthcare costs to the member. The member's personal information, PHI, and medical records will never be shared with any third party entity.

Members may cancel their membership at anytime by phone, email, or submitting a form through the website. Monthly membership fees that have been successfully paid for any calendar month may not be available for a pro-rated refund unless otherwise negotiated with the member of the "Covered" support team. Membership may also be terminated at any time if it is deemed that the member is suspected of abuse and/or misuse of reimbursement funds offered to the member by "Covered".

Applicants or members that use any form of tobacco, tobacco-related products, vapes, cannabis, and/or illegal or illicit drugs may be required to pay an increased monthly membership rate and/or be at risk of membership termination. Excessive alcohol use and/or abuse may also lead to the termination of membership and/or reimbursement benefits. By opting into the "Covered" club, members are agreeing to maintain a balanced and healthy lifestyle in order to keep club fees low for all members.

Costs covered:

Medications: Over the counter medications will not be reimbursed. Prescriptions will be reimbursed after the GoodRx discount. Members must either maintain a GoodRx membership or have the pharmacy apply the GoodRx discount in order for reimbursement to be approved unless otherwise negotiated with the "Covered" support team. Retail pharmacies and other discount prescription platforms such as Cost Plus Drug Company may be reimbursed upon approval.

Primary Care and Hospital Expenses:

"Covered" will only reimburse the discounted self-pay amount. If a member of "Covered" maintains an active health insurance policy and the medical care provider is unable to allow the member to use a self-pay cost rate, reimbursement for the non-discounted amount and/or any out of pocket health insurance amounts may not be reimbursed by "Covered" to their member. Please reach out to the "Covered" support staff if you need assistance in negotiating the self-pay amount with your provider.

Disclaimer

"Covered" is not an insurance company nor is the membership offered through an insurance company. "Covered" does not satisfy state or federal requirements for healthcare coverage or minimum essential coverage. This is not a legally binding agreement to reimburse or indemnify you for all medical expenses you incur. There is no guarantee of payment for medical expenses you incur. All submissions for reimbursement are subject to review by the reimbursement team. Reimbursements may not be made for submissions that are deemed elective, cosmetic, or non-essential by the reimbursement review team. Language in this document are subject to change. By accepting these current terms, each member agrees to any future amendments and/or changes in term and will be notified in advance via the email that was used for member enrollment.