Champion Benefit Advisors (“CBA”) is a licensed insurance agency which markets, sells and enrolls consumers (“Members,” “you” or “your”) in various insurance and non-insurance products throughout the United States.
Before obtaining services electronically from CBA, you must read and accept the online terms and conditions outlined in this Consent & Disclosure for Electronic Records agreement (“Agreement”). Your consent is required for CBA to use electronic records in connection with your membership account. Please read this entire Agreement.
By your agreement with the terms and conditions outlined below, you are providing your consent for CBA or our partners and affiliates to use electronic membership records. You are also confirming that you have the capabilities to receive and review your electronic membership records and that you have an active email account.
This Agreement, the Notice of Privacy Practices, and other documentation relevant to your membership or the services that are provided to you by CBA or our partners and affiliates may be provided to you in electronic format at our option. At your discretion, you may obtain paper “hard copy” membership materials by printing the package from your Member Portal.
We may, at our option, satisfy our obligation to provide you with an annual copy of our Notice of Privacy Practices by providing availability to it in your Member Portal.
All of your membership benefits are covered by your consent to access them electronically and remains in effect until you withdraw your consent.
Each Member agrees to receive their membership materials (including guides and ID cards) electronically, in addition to important notifications regarding their membership.
Each Member acknowledges and agrees that they will receive a “welcome” email within 24 hours of their membership enrollment, which will include their membership information. Members have the ability to download all materials, including temporary ID cards which can then be used until the official cards are received in the mail. It is each Member’s responsibility to thoroughly review all materials. Questions can be directed to Customer Service at (214) 436-8000.
Removing your consent will deny your access to your membership brochures, product information, and copies of your identification cards. You may withdraw your consent at any time. We will honor your request as soon as practicable. If you wish to remove your consent, please contact us by calling the Customer Service team at (214) 436-8000.
In order to provide you with your membership information, you must notify us of any change in your email address. To notify us, you may call (214) 436-8000.
In order for you to access and obtain your electronic membership records your system must meet the following requirements:
The User ID and password that are used to access your membership materials should be kept confidential. We strongly recommend that you change your password regularly. You are responsible for keeping your password, account numbers and other account data confidential.
You must promptly access and review your online account and notify us immediately of any error, unauthorized transaction, or any other irregularity. If you do not immediately report any error, irregularity, discrepancies, or unauthorized debits, you may experience delays in servicing requests if your information is not accurate.
Each Member consents and agrees to the use of electronic signatures of documents. Each Member consents and agrees that if they participated in a recorded verification call, my voice consent shall serve as my signature, their voice consent shall serve as their signature. Each Member agrees they will be fully responsible for reviewing the application which has been produced by this e-signature and will review such application carefully to ensure their full understanding of all provisions of the program.
I hereby consent to the use of electronic records in connection with the Member Portal, and I agree that all electronic records that CBA is required to give me in connection with these services may be sent to me at the email address I have provided on file with CBA.
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.
Almost all enrollments are conducted telephonically and include an e-sign authorization form, which is required with each enrollment. The purpose of the e-sign authorization form is to ensure that you understand, among other things, what program(s) you are enrolling in, what is included with that program, how much you are paying at the initial time of enrollment, how much you will pay monthly thereafter, and that subsequent monthly payments will be automatically drafted from the credit or banking account you provided.
I agree that I am signing up for services that include an automatic payment plan. I expressly authorize Premier Health Solutions, LLC, as the Third-Party Administrator for the program(s) I enrolled in today, 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 collected at the time of purchase). 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 (214) 436-8000. I understand that I may terminate the scheduled payments by contacting the Customer Service team five (5) business days 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, minus any non-refundable enrollment fees, on the monthly membership dues collected for that month. All cancellations must be directed to Customer Service at (214) 436-8000. Cancellations are processed Monday through Friday from 8 a.m. to 6 p.m. Central Time. 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 the payment has been drafted, the membership will terminate prior to the next billing date and the Member will have access to their membership through the next month. The billing department reserves the right to aggressively rebut and dispute any cancellation attempts made by Members via a “friendly” fraud chargeback, or similar-especially if no effort has been made to resolve the issue by contacting Customer Service.
By utilizing any of the services included in the membership during the first 30 days, I acknowledge and agree that constitutes acceptance of the membership, the program, and their terms and constitutes a waiver of any and all refund rights, including those noted in the foregoing paragraph.
Each Member acknowledges and agrees that, if included with their health program, the insurance policy purchased by the Member, is not a major medical or comprehensive medical insurance coverage, and is neither an Essential Health Benefit Plan under the federal Affordable Care Act (ACA) nor a policy of Worker’s Compensation under state law. Association membership benefits and services are exempt from the requirements of the 2010 Federal Health Care Reform Law, and depending upon each Member’s family and financial situation, they may be subject to the individual shared responsibility fee.
Each Member acknowledges and agrees that there may be a waiting period for pre-existing conditions for certain policies that are included with a health program. It is the Member’s responsibility to ensure they have determined if such a pre-existing condition applies to the policy included with their membership.
Each Member acknowledges and agrees that there may be a 30-day waiting period for sickness under certain policies that are included with a health program, and they will not receive benefits under such insurance for all covered sicknesses until their membership has been in effect for 30 days. Each Member acknowledges and agrees that pregnancy and/or childbirth may not be covered under certain policies that are included with their health program. It is the Member’s responsibility to ensure they have determined if such waiting periods or exclusions apply to the policy included with their membership.
Each Member acknowledges and agrees that, if applicable, as part of the health program purchased, they may have access to a PPO network. By using a doctor or facility in the PPO network, they may further reduce their healthcare costs through negotiated PPO discounted rates. It is the Member’s responsibility to ensure they have determined if such discounts are included with their membership.
If applicable, each Member acknowledges and agrees that if there is any discrepancy between what they thought the selling Agent told them about the membership plan purchased and what the actual policy states, the policy terms govern. It is the Member’s responsibility to understand the products purchased with their membership.
CBA reserves the right to change the terms and conditions of this agreement at any time. We shall update this agreement on your Member Portal and may notify you of such changes by email or written notice to your most recent address listed in our records. The notice will be posted or sent at least thirty (30) days in advance of the effective date of any changes. By using your Member Portal when the changes become effective, you agree to be bound by the revised terms and conditions contained in this agreement or you can decline the changes by discontinuing the use of your Member Portal internet account. CBA reserves the right to terminate this Agreement and your access to the website, in whole or in part, at any time.