Membership with Affinity Consumer Alliance (ACA) and Spartan Global Network (SGN) provides access to insured and non-insured benefits in exchange for payment of dues to the association. Affinity Consumer Alliance does not market or issue health insurance or any other insurance. An Affinity Consumer Alliance and Spartan Global Network membership is not an insurance contract. Health benefits available among the Affinity benefit packages such as but not limited to dental, prescription drugs, accident or illness payments, health and life insurance payments are issued by third party providers and are subject to the terms and conditions of such third party providers.
(ACA) and (SGN) are available to all members but they may vary based upon membership level, package option, or member’s state of residence and are subject to change. Certain limitations, reductions and exclusions may apply. Benefit providers reserve the right to withdraw or change their offers without notice. Benefit descriptions are taken from the benefit providers’ marketing materials and members should carefully examine benefit information before choosing any benefit. (ACA) and (SGN) makes no affirmation of fact or promise relating to the goods, services or benefits and specifically disclaims any warranty, expressed or implied, as to the merchantability of the goods, services or benefits or their suitability for the purposes desired or expected by member electing such benefit. To be entitled to (ACA) benefits, you must be a member in good standing and payment of dues must be current.
The (ACA) and (SGN) respects the privacy of our website visitors and members. The following privacy statement is provided so you will understand the information gathering and dissemination practices of (ACA).
THE INFORMATION WE COLLECT
(ACA) and (SGN) may collect and/or track for each visitor to the (ACA) and (SGN) website the following information: home server domain names, device used for access, type of operating system and web browser, non-user specific information on which pages of our website you access or visit, and information volunteered by the user such as site registrations and survey information. We may place cookies on visitors’ hard drives to save data about individual visitors such as name, password, user name, screen preferences, pages viewed or clicked by the visitor. Visitors may decline cookies by using the appropriate feature of their web software, if available.
HOW WE USE THE INFORMATION
(ACA) and (SGN) may use the information collected to improve the content of our website; analyze usage trends and measure demographics; customize the content and/or layout of the site for members who are logged in; support the operation of the site; and notify members about updates to our website. Member information may be made available to benefit providers for the purpose of determining benefit eligibility. Alliance limits disclosure of your information to those disclosures that are permitted or required by law.
(ACA) and (SGN) does not sell, rent or disseminate any nonpublic personal information you have provided to us. Whenever a benefit provider wants to promote their services to our members, we 1) review and approve the promotional materials and 2) receive the promotional materials from the benefit provider and conduct the distribution ourselves.
COLLECTION OF INFORMATION BY THIRD-PARTY SITES OR AD NETWORKS
Benefit providers administer their own websites by which they provide their services to Alliance members. When a member chooses to take advantage of a service, he/she makes direct contact with the third party. These companies have their own privacy and data collection practices and are not covered by this policy.
(ACA) does not partner with or have special relationships with any ad server companies.
COLLECTION OF DATA FROM CHILDREN
This website is not intended for use by children under the age of 13. (ACA) will not knowingly collect or post information for or about children under 13 without parent or guardian consent.
HOW YOU CAN ACCESS OR CORRECT INFORMATION
(ACA) and (SGN) Members have access to and can edit the following member account information from the “My Web Account” page: Password; Email address; Billing address; Shipping address for web orders. (ACA) Members can also view, but not edit, the following member account information: User name; Member number; Membership plan type; Year of account creation; Order history.
SECURITY OF YOUR PERSONAL INFORMATION
We always use industry-standard encryption technologies when transferring and receiving personal data exchanged with our site. When we transfer and receive certain types of sensitive information we redirect visitors to a secure server. We have appropriate security measures in place in our physical facilities in order to seek to protect against the loss, misuse or alteration of information that we have collected from you at our site.
Visitors may opt-out of having their personal information used by Alliance to send promotional correspondence or educational materials by writing to the address or calling the phone number below during business hours.
CHANGES TO THIS STATEMENT
From time to time, we may use visitor and member information for new, unanticipated uses not previously disclosed in our privacy notice. If our information practices change at some time in the future we will post the policy changes to our website to notify you of these changes. If you are concerned about how your information is used, you should check back at our website periodically.
If you feel that this site is not following its stated information policy, you may contact us at the address or phone number below.
If you are not satisfied within the first 30 days of becoming a member, you may cancel your membership in writing to 16476 Wild Horse Creek Road, Chesterfield, MO 63017 or email firstname.lastname@example.org. The one-time registration fee and money paid for healthcare services and products are not refundable. After 30 days membership fees are non-refundable. You may cancel your membership at any time by written request. Attempts to cancel by telephone will not be accepted.
3. E Signature Language
Thank you for enrolling in a membership plan through us! We endeavor to clarify as much as possible the process and obligations between us and have found that providing this confirmation is one of the best ways to start the relationship. Please review and acknowledge your understanding of the below. Once completed, a copy of this form will be provided in the member portal for your records.
INTENDED USE VERIFICATION
By enrolling today, I agree and affirm I am enrolling for the sole purpose the plans are intended for and further affirm I was contacted because I provided my contact information for this very purpose.
I further affirm I am not enrolling for the purpose of making threats or demands for money by alleging violations of the telephone consumer protection act and/or federal trade commission do not call registry or regulations. I expressly indemnify all parties involved in enrolling in these product(s) from any alleged violations, or threats of litigation, as it relates to the telephone consumer protection act or federal trade commission do not call registry related violations.
[Affinity Consumer Alliance/Spartan Global Network Product level 1-4]
I agree and acknowledge that the [Affinity Consumer Alliance/Spartan Global Network Product level 1-4]] membership includes Group Term Life Insurance benefits provided by Guarantee Trust Life Insurance Company, Glenview, IL (GTL) as well as a selection of Association Benefits provided by [Affinity Consumer Alliance]
I acknowledge and understand that the Group Term Life Insurance Only insurance is issued on Certificate Form Series GLC-3002
I acknowledge and agree that some of the benefits have pre-existing condition limitations and it is my responsibility to read my materials and certificates thoroughly to ensure I understand these limitations.
I ACKNOWLEDGE AND AGREE THAT I AM STRONGLY ENCOURAGED AND ADVISED TO READ ALL MEMBERSHIP AND POLICY MATERIALS CAREFULLY AND TO GO OVER ANY QUESTIONS OR CONCERNS WITH MY AGENT, FINANCIAL ADVISOR, A FAMILY MEMBER, OR A TRUSTED INDIVIDUAL WHO MAY BETTER UNDERSTAND SUCH MEMBERSHIP AND POLICIES MATERIALS.
I agree that I am signing up for benefits or services that include an automatic payment plan. I expressly authorize [Affinity Consumer Alliance/Spartan Global Network /Premier Administrative Solutions] to automatically debit my bank account or credit card on the payment due date provided to collect any and all fees and membership dues for my membership. I acknowledge and agree upon the membership effective date and the initial payment amount (this is comprised of the first month’s membership dues, and if applicable, a one-time, non-refundable enrollment processing fee). I also acknowledge and agree that my monthly dues will be automatically charged or drafted every month from the credit card, debit card or bank account I provided. Further, I attest that I am the holder of the credit card, debit card or bank account provided.
I may cancel automatic payments at any time by calling Customer Service at (800) 992-8044. I understand that I may terminate the scheduled payments by providing notification to the Customer Service team five (5) business day prior to the next scheduled payment date. This advance notice allows processing time to ensure the termination occurs prior to the next scheduled payment date. Automatic payment termination cannot be guaranteed with respect to notice provided outside of this window.
If I am not satisfied with my membership, I may cancel within thirty (30) days from my membership’s effective date and I may be eligible to receive a full refund on the monthly membership dues collected for that month. All cancellations must be directed to Customer Service at (800) 992-8044. All cancellation requests must be made five (5) days prior to the billing date in order to cancel the membership for that month. This advance notice allows processing time to ensure the cancellation occurs prior to the next scheduled payment date. Cancellations cannot be guaranteed with respect to notice provided outside of this window. If a cancellation request is received on or after the recurring billing date and the payment has been drafted, the membership will terminate prior to the next billing date and the member will be covered through the next month.
By submitting a claim during the first 30 days, I acknowledge and agree that such a submission constitutes acceptance of the membership, the products, and their terms and submission of such a claim constitutes a waiver of any and all refund rights, including those noted in the foregoing paragraph.
I acknowledge and agree that if there is any discrepancy between what I thought the selling Agent told me about the membership plan purchased and what the actual policies state, the policy terms govern.
By enrolling in this [Affinity Consumer Alliance/Spartan Global Network Product level 1-4]] membership, I agree to receive my membership materials, including instruction guides and insurance certificates, through a secure, online member portal, as well as receive important notifications regarding my membership via email.
I acknowledge and agree that I will receive a “welcome” email immediately upon enrollment, which will include access to my membership information. I have the ability to download all materials, including benefit guide(s) and certificates. It is my responsibility to thoroughly review all materials. Questions can be directed to Customer Service at (800) 992-8044.
NOTICE OF VOICE CONSENT TO ELECTRONIC TRANSACTIONS, SIGNATURES AND DOCUMENTS
I consent and agree to the use of electronic signatures of documents. I consent and agree that if I participated in a recorded verification call, my voice consent shall serve as my signature. I agree I am fully responsible for reviewing this application verification and I have reviewed such application carefully to ensure my full understanding of all provisions of the coverage.
By signing below, I agree to receive all documents and correspondence electronically and that I can access the internet, or the email address provided.
CONSENT TO ELECTRONIC TRANSACTIONS
I agree that, by using this website, my agreement or consent shall be legally binding and enforceable and the legal equivalent of my handwritten or manual signature.
I agree that I have a full and complete understanding of the plan for which I am applying. I certify that I am the applicant listed above.
The information in this Enrollment Form is true and complete as of the date I signed this Enrollment Form. I elect to participate in the plan indicated above.
All sales are conducted on line and include an e-sign authorization form, which is required with each sale. The purpose of the e-sign authorization form is to ensure that you understand, among other things, what product you are purchasing, what benefits are included with that product, how much you are paying at the initial time of sale, how much you will pay monthly thereafter, and that all subsequent monthly payments will be automatically drafted from the credit or banking account you provided.
HOW TO CONTACT US
Affinity Consumer Alliance
16476 Wild Horse Creek Road.
Chesterfield, MO. 63017