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| HOW MUCH DO I PAY? |
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| The annual Premium for the initial Contract Term is: |
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Enrollee only (one person):
plus a onetime enrollment fee of $15 |
$105 |
Enrollee and one dependent (spouse or child):
plus a onetime enrollment fee of $15 |
$173 |
Enrollee and two or more dependents:
plus a onetime enrollment fee of $15 |
$255 |
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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.
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 Notice of Insured's Right to Examine Policy for Ten Days. |
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