Company A Enrollment | Thrift Benefits

Thrift Benefits > Company A Enrollment

Please print and fill out the Enrollment form below and turn it in to HR.

company-a-enrollment-4-22-2016

*This is an example form. We can either white-label it for your company or you can use your current payroll deduction form.

DISCLOSURES

This discount card program is NOT insurance, not intended to replace insurance, and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CRM 5.00. It contains a 30-day cancellation period, provides discounts only at the offices of contracted health care providers, and each member is obligated to pay the discounted medical charges in full at the point of service. For a complete list of disclosures, please click here. | Limitations, Exclusions and Exceptions | Discount Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box 803475, Dallas, TX 75380-3475.

NOT available in KS, UT, VT or WA. TeleHealth operates subject to state regulation and may NOT be available in certain states. Pharmacy discounts range from 10% to 85% on most medications. Discount lab work benefit is NOT available to MD, NJ, NY, or RI residents.