TERMS OF SERVICE

Effective Date: 06/05/2026
Last Updated: 06/05/2026

1. Introduction

Welcome to [Company Name] ("Company," "we," "our," or "us"). These Terms of Service ("Terms") govern your access to and use of our health insurance products, services, websites, mobile applications, customer portals, and related offerings (collectively, the "Services").

By enrolling in, accessing, or using our Services, you agree to be bound by these Terms. If you do not agree with these Terms, you should not access or use our Services.

2. Eligibility

To use our Services, you must:

• Be at least eighteen (18) years of age or the legal age of majority in your jurisdiction.
• Have the legal capacity to enter into binding agreements.
• Provide accurate and complete information during registration and enrollment.
• Meet any eligibility requirements established by applicable insurance regulations and underwriting standards.

We reserve the right to deny, suspend, or terminate access to our Services if eligibility requirements are not met.

3. Definitions

For purposes of these Terms:

• "Member" means an individual enrolled in a health insurance plan offered by the Company.
• "Policy" means the health insurance contract issued to the Member.
• "Premium" means the amount payable for insurance coverage.
• "Claim" means a request for payment or reimbursement of covered medical expenses.
• "Provider" means a healthcare professional, hospital, clinic, pharmacy, or other healthcare entity.
• "Covered Services" means healthcare services eligible for benefits under the applicable Policy.

4. Account Registration

To access certain Services, you may be required to create an account.

You agree to:

• Provide accurate, current, and complete information.
• Maintain and update your information as necessary.
• Protect the confidentiality of your login credentials.
• Notify us immediately of any unauthorized access or security breach.

You are responsible for all activities occurring under your account.

5. Health Insurance Coverage

Coverage is governed primarily by the specific insurance Policy issued to you.

The Policy shall determine:

• Covered benefits.
• Coverage limits.
• Deductibles.
• Copayments and coinsurance.
• Waiting periods.
• Exclusions and limitations.
• Network provider requirements.
• Claim procedures.

If there is any conflict between these Terms and the Policy, the Policy shall prevail with respect to insurance coverage matters.

6. Premium Payments

Members must pay all premiums by the due date specified in the Policy.

Failure to make timely payments may result in:

• Coverage suspension.
• Coverage termination.
• Denial of claims incurred during periods of non-payment.
• Additional fees as permitted by law.

The Company reserves the right to modify payment methods and billing procedures upon notice.

7. Claims and Reimbursement

Claims must be submitted according to Company procedures and within applicable deadlines.

The Company may require:

• Medical records.
• Provider invoices.
• Prescriptions.
• Diagnostic reports.
• Other supporting documentation.

The Company reserves the right to investigate claims for accuracy and eligibility.

Submission of a claim does not guarantee approval or payment.

8. Preauthorization Requirements

Certain medical services, treatments, procedures, medications, or hospital admissions may require prior authorization.

Failure to obtain required authorization may result in:

• Reduced benefits.
• Partial reimbursement.
• Claim denial.

Members should consult applicable Policy documents for specific authorization requirements.

9. Member Responsibilities

Members agree to:

• Provide truthful and accurate information.
• Cooperate with claim investigations.
• Notify the Company of material changes affecting coverage.
• Use Services in compliance with applicable laws.
• Avoid fraudulent or abusive activities.

Members shall not knowingly submit false information or misrepresent medical conditions.

10. Fraud Prevention

The Company maintains a zero-tolerance policy regarding fraud.

Examples of prohibited conduct include:

• Submitting false claims.
• Misrepresenting medical conditions.
• Falsifying documentation.
• Using another person's insurance benefits.
• Concealing relevant health information when required.

The Company may report suspected fraud to law enforcement agencies, regulatory authorities, or other appropriate entities.

11. Provider Networks

Certain plans may require Members to obtain services through designated provider networks.

The Company does not guarantee:

• Provider availability.
• Provider acceptance of new patients.
• Specific treatment outcomes.
• Continued participation of providers within a network.

Provider participation may change without notice.

12. Telehealth Services

Where available, telehealth services are provided subject to applicable laws and regulations.

Members acknowledge that:

• Telehealth may not be suitable for all conditions.
• Technical issues may affect service availability.
• Emergency medical situations require immediate in-person care or emergency services.

The Company is not responsible for the medical decisions of healthcare providers delivering telehealth services.

13. Privacy and Health Information

The Company collects, processes, stores, and discloses personal information in accordance with applicable privacy laws and our Privacy Policy.

Information collected may include:

• Personal identification information.
• Medical information.
• Billing information.
• Claims history.
• Communication records.

Members consent to the use of such information for:

• Policy administration.
• Claims processing.
• Regulatory compliance.
• Fraud prevention.
• Customer support.
• Healthcare operations.

14. Data Security

We implement reasonable administrative, technical, and physical safeguards to protect personal information.

However, no system can guarantee absolute security. Members acknowledge the inherent risks associated with electronic communications and internet-based services.

15. Exclusions and Limitations

Coverage may exclude certain services, including but not limited to:

• Experimental treatments.
• Cosmetic procedures.
• Non-medically necessary services.
• Services excluded by the applicable Policy.
• Treatments prohibited by law.

Specific exclusions are detailed in the applicable Policy documentation.

16. Limitation of Liability

To the maximum extent permitted by law, the Company shall not be liable for:

• Indirect damages.
• Incidental damages.
• Consequential damages.
• Loss of profits.
• Emotional distress damages.
• Provider negligence or malpractice.

The Company's total liability shall not exceed amounts required by applicable law or the applicable Policy.

17. No Medical Advice

The Services are intended for insurance administration and informational purposes only.

Nothing in the Services constitutes:

• Medical advice.
• Medical diagnosis.
• Medical treatment.
• Professional healthcare recommendations.

Members should consult qualified healthcare professionals regarding medical concerns.

18. Intellectual Property

All content provided through the Services, including:

• Logos.
• Trademarks.
• Software.
• Designs.
• Text.
• Graphics.

remains the property of the Company or its licensors.

No rights are granted except as expressly stated in these Terms.

19. Service Availability

The Company strives to maintain continuous access to the Services but does not guarantee uninterrupted availability.

We may:

• Perform maintenance.
• Modify features.
• Suspend services temporarily.
• Discontinue services where permitted by law.

20. Termination

The Company may suspend or terminate access to Services if:

• These Terms are violated.
• Fraudulent activity is suspected.
• Required payments are not made.
• Access is required to comply with legal obligations.

Termination of access does not automatically terminate insurance coverage unless permitted by the applicable Policy and law.

21. Regulatory Compliance

All Services are subject to applicable insurance laws, healthcare regulations, and governmental requirements.

Nothing in these Terms shall be interpreted to limit rights granted under applicable law.

22. Dispute Resolution

Any dispute arising under these Terms shall first be addressed through good-faith negotiations.

If unresolved, disputes may be resolved through:

• Mediation.
• Arbitration.
• Courts of competent jurisdiction.

The applicable dispute resolution process shall be governed by the laws of [Jurisdiction].

23. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the United States of America under the Center for Medicaid and Medicare Services(CMS), without regard to conflict-of-law principles.

24. Changes to Terms

The Company may modify these Terms from time to time.

Updated Terms will be posted through the Services and become effective upon publication unless otherwise required by law.

Continued use of the Services after modifications constitutes acceptance of the revised Terms.

25. Contact Information

For questions regarding these Terms, please contact:

SignUp4Insurance
Address: 5840 S Semoran BLVD, Orlando FL 32822
Email: info@signup4insurance.com
Phone: +1-888-440-6176
Website: https://www.signup4insurance.com/ 



26. Entire Agreement

These Terms, together with the applicable Policy, Privacy Policy, and related documents, constitute the entire agreement between the Member and the Company regarding the Services.

By using the Services, you acknowledge that you have read, understood, and agreed to these Terms of Service.