Enrollee only (one person): plus a onetime enrollment fee of $15
$123
Enrollee and one dependent (spouse or child): plus a onetime enrollment fee of $15
$202
Enrollee and two or more dependents: plus a onetime enrollment fee of $15
$299
A full refund of Premium, including the one time enrollment fee, is available if the written request for refund is made within the first month of the Contract Term. Thereafter, requests for Premium refund will be pro-rated based upon the number of months remaining in the Contract Term subject to the following conditions:
The one-time enrollment fee is not refundable after the first month of coverage;
You, or your covered dependents, have not received any Benefits under the DeltaCare USA program;
There is at least one month remaining in the Contract Term;
Coverage is based on a full calendar month. There are no partial month refunds.
Should the death of an Enrollee occur during a period for which premium has been paid, we will refund the portion of the premium that applies to the period beyond the end of the month in which the death occurred.
The above refund period starts on the original Effective Date of your Program. This provision provides you with rights in addition to those described in the Right to Examine Disclosure Form/Contract.
