Alliance Limited Medical MEC

 Alliance Limited Benefit Medical MEC plan is not a comprehensive major medical plan, nor is it intended to replace a major medical plan.  The plan is intended to meet the Minimum Essential Coverage to provide you, and your covered dependents, with first dollar coverage that is capped at specific amounts for specific services.  Member benefits include Preventive Care & Covid Testing with a $0 copay for in-network providers! You can use your benefit to pay for medical expenses or for expenses related to your medical event including to help with lost wages.  

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Alliance Limited Benefit Medical

A Limited Benefit Medical plan is not a comprehensive major medical plan, nor is it intended to replace a major medical plan. The plan is intended to provide you, and your covered dependents, with first dollar coverage that is capped at specific amounts for specific services. You can use your benefit to pay for medical expenses or for expenses related to your medical event including to help with lost wages.

What is included?

Hospital Stays Benefits

This plan includes a hospital stays benefit – which means you will receive a set amount when you are confined in a hospital. The benefits are paid directly to you or your designee. Plan benefits range from:

  • Inpatient Hospital Stay :$100/day, $200/day, $400/day, $500/day, $750/day, $1,000/day
  • Maximum Benefit Days (Per Plan Year): 30
  • Maximum Benefit Amount (Per Plan Year): $3,000, $6,000, $9,000, $15,000, $22,500, $30,000

Doctor Visits Benefits

This plan includes a doctor visit benefit – which means you will receive a set amount if you have to visit the doctor due to an accident or illness. The benefits are paid directly to you or your designee.

  • Physician Office Visit: $25 co-pay (Physician);  $50 co-pay (Specialty)
  • Maximum Visits (per Plan Year):  4 (four) visits per year (Physician) per covered member;  2 (two) visits per year (Specialty)  per covered member
  • Maximum Benefit Amount (Per Plan Year): $25 copay (Physician)  Maximum fee of $150;  $50 copay (Specialty) Maximum fee of $150
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Plan Details

Fixed Indemnity / Limited Medical / MEC
 Essentials PlanValue PlanBasic PlanChoice PlanPreferred Plan
Wellness & Preventive CareNo Co-Pay. Plan covers 100% of Adult Wellness & Preventive Care, Women’s Wellness & Preventive Care, Child Wellness & Preventive Care.
Outpatient Physician Office VisitsMaximum 2 visits per plan year, per insured. Up to 1 visit can used for Specialty Office visits per plan year, per insured.Maximum 6 visits per plan year, per insured. Up to 2 visits can used for Specialty Office visits per plan year, per insured.Maximum 4 visits per plan year, per insured. Up to 2 visits can be used for Speciality Office visits per plan year, per insured.Maximum 4 visits per plan year, per insured. Up to 2 visits can be used for Speciality Office visits per plan year, per insured.Maximum 4 visits per plan year, per insured. Up to 2 visits can be used for Speciality Office visits per plan year, per insured.
Outpatient Physician Office Visits$25 co-pay (Physician), $50 co-pay (Specialty) for all covered illness or injury related outpatient visits at a primary care physician office, urgent care, or retail medical clinic.  Plan pays up to $150 for services rendered per visit after co-pay.  Plan does not cover illness or injury visits in-hospital or at an emergency room.
Covered Annual Preventative Care Visit

1 time per plan year (as long as number of Outpatient Physician Office Visits has not been exhausted)

History, Physical exam, Measurements (Height, Weight & Body Mass Index)

Preventative CareN/AN/AACA Preventative ServicesACA Preventative ServicesACA Preventative Services
CopaysN/AN/A$0$0$0
DeductibleN/AN/A$0$0$0
Benefit % Payable by PlanN/AN/A100%100%100%
Plan Annual MaximumN/AN/AUnlimitedUnlimitedUnlimited
Plan Lifetime MaximumN/AN/AUnlimitedUnlimitedUnlimited
TeladocN/AN/ANo cost access to doctors by phone or onlineNo cost access to doctors by phone or onlineNo cost access to doctors by phone or online
Outpatient Diagnostic LabN/AN/AN/A$100 per testing day; 3 days per year$150 per testing day; 3 days per year
Outpatient Diagnostic X-RayN/AN/AN/A$125 per testing$125 per testing
Outpatient Advanced StudiesN/AN/AN/A$100 per testing day; 3 days per year$100 per testing day; 3 days per year
Outpatient Radiology/PathologyN/AN/AN/A$40 per day; 3 days per plan year$50 per day; 3 days per plan year
Accidental Injury CareN/AN/AUp to $300 per occurrenceUp to $300 per occurrenceUp to $300 per occurrence
Emergency Room InjuryN/AN/AN/A$500 per day; up to 2 days per year$500 per day; up to 2 days per year
Emergency Room SicknessN/AN/A$75 per day; up to 4 days per year$75 per day; up to 4 days per year$75 per day; up to 4 days per year
Urgent CareN/AN/AN/A$50 per day; 1 day per year$60 per day; 1 day per year

 

Essentials Plan

Value Plan

Basic Plan

Choice Plan

Preferred Plan

– Inpatient

N/A

N/A

N/A

$500 per day; 1 day per year

$1,000 per day; 1 day per year

– Outpatient

N/A

N/A

N/A

$500 per day

$500 per day

– Outpatient – Minor

N/A

N/A

N/A

$100 per day

$100 per day

– Outpatient – Benefit Max

N/A

N/A

N/A

1 day per year

1 day per year

Anesthesia

N/A

N/A

N/A

30% of Surgical Benefit

30% of Surgical Benefit

Hospital Admission – Cancer

N/A

N/A

N/A

$2,000 per day; 1 day per year

$4,000 per day; 1 day per year

Hospital Admission – Heart Attack

N/A

N/A

N/A

$2,000 per day; 1 day per year

$4,000 per day; 1 day per year

Hospital Admission – Heart Disease

N/A

N/A

N/A

$1,000 per day; 1 day per year

$2,000 per day; 1 day per year

Hospital Admission – Stroke

N/A

N/A

N/A

$2,000 per day; 1 day per year

$4,000 per day; 1 day per year

Hospital Admission – Childbirth

N/A

N/A

N/A

$1,000 per day; up to 1 day per year

$2,000 per day; up to 1 day per year

Outpatient Surgical Facility

N/A

N/A

N/A

$500 per day; 1 day per year

$1,000 per day; 1 day per year

Daily Hospital Indemnity

N/A

N/A

$100 per day

$200 per day

$500 per day

– Intensive Care Unit

N/A

N/A

$200 per day

$400 per day

$1,000 per day

– Mental Illness Disorder

N/A

N/A

$50 per day

$100 per day

$100 per day

– Substance Abuse

N/A

N/A

$50 per day

$100 per day

$100 per day

– Inpatient Skilled Nursing

N/A

N/A

$50 

$100 

$100 

Hospital Admission

N/A

N/A

500 day lifetime

500 day lifetime

500 day lifetime

 Essentials PlanValue PlanBasic PlanChoice PlanPreferred Plan
– EmployeeN/AN/A$5,000$5,000$5,000
– Spouse / Child (Life Only)N/AN/A$2,500 / $1,250$2,500 / $1,250$2,500 / $1,250
Pharmacy BenefitN/AN/ABMRBMRBMR
Network ProviderN/AN/APHCSPHCSPHCS
 Essentials PlanValue PlanBasic PlanChoice PlanPreferred Plan
Individual$46.67$58.67$61.95$116.05$170.25
Individual + Spouse$60.00$82.67$87.47$178.14$285.91
Individual + Child(ren)$66.67$90.67$95.47$196.17$308.33
Individual + Family$82.67$125.33$130.13$292.30$475.55
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Also Included:

Telemedicine, Prescription Drug and Rx Benefits for Everyone. Click the tabs below for more information.
logo for CareClix

CareClix

Telemedicine allows health care professionals to evaluate, diagnose, and treat patients at a distance using telecommunications technology. The approach has been through a striking evolution in the last decade and it is becoming an increasingly important part of the Global healthcare infrastructure.

CareClix telemedicine solutions puts your doctors on a single platform to expand the points of care for patients

How it works

Benefits for Everyone members are empowered through the CareClix Anywhere patient connected medical hub. This is easy to use across multiple platforms (iOS, Android, PC, Tablet) which ensures members are able to conveniently be seen by the right doctor in a safe and expedient manner.

  • Illness or medically related question
  • Connect with an expert
  • Have your medical questions answered

Connect with your doctor in 3 convenient ways:

  1. Mobile Apps
  2. Website
  3. Over the Phone

Primary Care Consultant

Virtual delivery of health care is replacing costly wait times, which often places you in close proximity to other more sickly patients. The ease of connecting to a physician makes this service extremely valuable, as routine medical encounters can be handled quickly via the telemedicine service, rather than requiring an in person doctor visit. You can be connected with a trusted local provider who will take care of your needs!

Prescription Drug Schedule of Benefitsbmr logo

Provider: Broadreach Medical Rx – 866-718-2375 – www.bmr-inc.com

Pharmacy Subscription Plan – Contact Broadreach Medical Rx at 866-718-2375 during business hours of 8:00 AM and 6:00 PM EST. The web address is www.bmr-inc.com where you can register and place and renew Mail Order prescriptions. You will need either a written physician prescription or have your doctor call in the prescription.

Broadreach Medical Rx is the administrator of the pharmacy drug plan. You must use a participating pharmacy to fill your prescription. To fill a prescription, you must show the pharmacy your Plan ID card.

Member Responsibility

All Medications under the ACA/MEC Plan are covered at 100%. See formulary for details.

Mail Order Drug Benefit

The Mail Order drug benefit is used for member convenience. All medications on the specific formulary can be shipped directly to members home at no charge. Other medications that are not part of the formulary will be offered at a deep discount.

Covered Prescription Drugs

  1. Read the Drug Formulary to see which drugs are covered.
  2. Retail Pharmacies are limited to a 30-day supply. Mail Order drugs are limited to a 90-day supply in most cases. Some medications qualify for a 30 day fill via mail order.
  3. In certain cases, if a drug is available from alternative sources, Broadreach Medical Rx will make all options available to the covered person. If a drug is not on the formulary, (Non Formulary with Exceptions) Broadreach Medical Rx will provide advocacy to the Covered Person for such medications.

rx benefits for everyone logo

Drug prices vary drastically by pharmacy locations. Rx Benefits for Everyone helps you find the lowest prescription drug prices and discount coupons. If you are uninsured, Rx Benefits for Everyone can help you find great savings on prescription medications. If you do have health insurance, Rx Benefits for Everyone may offer a lower price than your insurance co-pay.

 

Get Free Coupons and Save Up to 85% on Rx

Alliance Limited Medical Plans Summary of Coverages
The list below summarizes all wellness and preventative services covered under all Alliance limited medical plans services not listed under wellness and preventive are not covered under the plans. All covered wellness and preventative services do not require a co pay and are covered 100 by the plans.

Covered Preventative Services for Adults (Ages 18 and Older)
BENEFIT DESCRIPTIONCOVERAGE LIMITATIONS
Abdominal Aortic Aneurysm screeningOne-time screening for age 65-75
Blood Pressure screeningOne-time per plan year
Cholesterol screeningOne-time per plan year
Type 2 Diabetes screeningOne-time per plan year
Hepatitis B screening for adults at high riskOne-time per plan year
Hepatitis C screening for adults at high riskOne-time per plan year
Immunization vaccines: Hepatitis A&B, Herpes Zoster, Human Papiloma virus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis and VaricellaOne-time per plan year per immunization
Obesity screening & counselingOne-time per plan year
Sexually Transmitted Infection (STI) prevention counselingOne-time per plan year
Syphilis screeningOne-time per plan year
Covered Preventative Services for Women (Ages 18 and Older)
BENEFIT DESCRIPTIONCOVERAGE LIMITATIONS
BRCA counseling and genetic testingOne-time per plan year for women at higher risk
Breast Cancer Mammography screeningsOne-time per plan year for women age 40+
Breast Cancer Chemo prevention counselingOne-time per plan year
Cervical Cancer screeningOne-time per plan year
Gestational Diabetes screeningOne-time per plan year
Hepatitis B screeningOne-time per plan year
HIV screening & counselingOne-time per plan year
Human Papiloma virus (HPV) DNA testOne-time every 3 years for women with normal cytology age 30+
Osteoporosis screeningOne-time per plan year for women age 60+
Well-woman visitsTo obtain recommended preventative services
Covered Preventative Services for Children
BENEFIT DESCRIPTIONCOVERAGE LIMITATIONS
Immunization vaccines: Hepatitis A&B, Herpes Zoster, Human Papiloma virus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis and VaricellaOne-time per plan year per immunization
Autism screeningLimited to 2 screenings up to age 26 months
Blood Pressure screeningOne-time per plan year
Congenital Hypothyroidism screeningOne-time per plan year for newborns up to age 3 month
Phenylketonuria (PKU) screeningOne-time per plan year for newborns up to age 3 month
Sexually Transmitted Infection (STI) prevention counseling and screeningOne-time per plan year for adolescents age 12-17 years
Tuberculin testingOne-time per plan year
Vision screeningOne-time per plan year for children up to age 5
Limitations Exclusions

Some health care services are not covered by the Plan. Coverage is not available from the Plan for charges arising from care, supplies, treatment, and/or services:

Administrative Costs: That are solely for and/or applicable to administrative costs of completing claim forms or reports or for providing records wherever allowed by applicable law and/or regulation.

After the Termination Date: That are Incurred by the Participant on or after the date coverage terminates, even if payments have been predetermined for a course of treatment submitted before the termination date, unless otherwise deemed to be covered in accordance with the terms of the Plan or applicable law and/or regulation.

Alcohol: Involving a Participant who has taken part in any activity made illegal due to the use of alcohol or state of intoxication. Expenses will be covered for Injured Participants other than the person partaking in an activity made illegal due to the use of alcohol or state of intoxication, and expenses may be covered for Substance Abuse treatment as specified in the Plan, if applicable. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).

Broken Appointments: That are charged solely due to the Participant’s having failed to honor an appointment.

Complications of Non-Covered Services: That are required as result of complications from a service not covered under the Plan, unless expressly stated otherwise.

Confined Persons: That are for services, supplies, and/or treatment of any Participant that were Incurred while confined and/or arising from confinement in a prison, jail or other penal institution with said confinement exceeding 24 consecutive hours.

Cosmetic Surgery: That are Incurred in connection with the care and/or treatment of Surgical Procedures which are performed for plastic, reconstructive or cosmetic purposes or any other service or supply which are primarily used to improve, alter or enhance appearance, whether or not for psychological or emotional reasons, except to the extent where it is needed for: (a) repair or alleviation of damage resulting from an Accident; (b) because of infection or illness; (c) because of congenital Disease, developmental condition or anomaly of a covered Dependent Child which has resulted in functional defect. A treatment will be considered cosmetic for either the following reasons:
(a) its primary purpose is to beautify or (b) there is no documentation of a clinically significant impairment, meaning decrease in function or change in physiology due to the injury, illness or congenital abnormality. The term “cosmetic services” includes those services which are described in IRS Code Section 213(d)(9).

Custodial Care: That do not restore health, unless specifically mentioned otherwise.

Deductible: That are amounts applied toward satisfaction of Deductibles and expenses that are defined as the Participant’s responsibility in accordance with the terms of the Plan.

Excess: That exceed Plan limits, set forth herein and including (but not limited to) the Maximum Allowable Charge in the Plan Administrator’s discretion and as determined by the Plan Administrator, in accordance with the Plan terms as set forth by and within this document.

Experimental: That are Experimental or Investigational.

Family Member: That are performed by a person who is related to the Participant as a spouse/domestic partner, parent, child, brother or sister, whether the relationship exists by virtue of “blood” or “in law”.

Foreign Travel: That are received outside of the United States if travel is for the purpose of obtaining medical services, unless otherwise approved by the Plan Administrator.

Government: That the Participant obtains, but which is paid, may be paid, is provided or could be provided for at no cost to the Participant through any program or agency, in accordance with the laws or regulations of any government, or where care is provided at government expense, unless there is a legal obligation for the Participant to pay for such treatment or service in the absence of coverage. This Exclusion does not apply when otherwise prohibited by law, including laws applicable to Medicaid and Medicare.

Government-Operated Facilities: That meet the following requirements:
That are furnished to the Participant in any veteran’s Hospital, military Hospital, Institution or facility operated by the United States government or by any State government or agency or instrumentality of such governments.

That can be paid for by any government agency, even if the patient waives his rights to those services or supplies.

Note: This Exclusion does not apply to treatment of non-service-related disabilities or for Inpatient care provided in a military or other Federal gove

Illegal Acts: That are for any Injury or Sickness which is Incurred while taking part or attempting to take part in an illegal activity, including but not limited to misdemeanors or felonies. It is not necessary that an arrest occur, criminal charges be filed, or, if filed, that a conviction result. Proof beyond a reasonable doubt is not required to be deemed an illegal act. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).

Illegal Drugs or Medications: That are services, supplies, care or treatment to a Participant for Injury or Sickness Incurred while the Participant was voluntarily taking or was under the influence of any controlled substance, drug, hallucinogen or narcotic not administered n the advice of a Physician. This Exclusion will apply even if the Participant has prescription for the drug and the drug is legal in the state where the Participant lives. Expenses will be covered for Injured Participants other than the person using controlled substances and expenses will be covered for Substance Abuse treatment as specified in this Plan. This Exclusion does not apply if the Injury (a) resulted from being the victim of an act of domestic violence, or (b) resulted from a documented medical condition (including both physical and mental health conditions).
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Incurred by Other Persons: That are expenses Incurred by other persons.

LongTerm Care: That are related to long term care.

Medical Necessity: That are not Medically Necessary and/or arise from services and/or supplies that are not Medically Necessary.

Military Service: That are related to conditions determined by the Veteran’s Administration to be connected to active service in the military of the United States, except to the extent prohibited or modified by law.

Negligence: That are for Injuries resulting from negligence, misfeasance, malfeasance, nonfeasance or malpractice on the part of any care- giver, Institution, or Provider, as determined by the Plan Administrator, in its discretion, considering applicable laws and evidence available to the PlanAdministrator.

No Coverage: The at are Incurred at a time when no coverage is in force for the applicable Participant and/or Dependent.

No Legal Obligation: That are for services provided to a Participant for which the Provider of a service does not and/or would not customarily render a direct charge, or charges Incurred for which the Participant or Plan has no legal obligation to pay, or for which no charges would be made in the absence of this coverage, including but not limited to charges for services not actually rendered, fees, care, supplies, or services for which a person, company or any other entity except the Participant or the Plan, may be liable for necessitating the fees, care, supplies, or services.

Non-Prescription Drugs: That are for drugs for use outside of a Hospital or Inpatient facility that can be purchased over the counter and without a Physician’s written prescription. Drugs for which there is a non-prescription equivalent available. This does not apply to the extent the non-prescription drug must be covered under Preventative Care, subject to the Affordable Care Act.

Not Acceptable: That are not accepted as standard practice by the American Medical Association (AMA), American Dental Association (ADA), or the Food and Drug Administration (FDA).

Not Covered Provider: That are performed by Providers that not satisfy all the requirements per the Provider definition as defined within this Plan.

Not Specified as Covered: That are not specified as covered under any provision of this Plan.

Other than Attending Physician: That are other than those certified by a Physician who is attending the Participant as being required for treatment of Injury or Disease and performed by an appropriate Provider.

Personal Injury Insurance: That are in connection with an automotive accident for which benefits payable hereunder are, or would be otherwise covered by, mandatory no-fault automobile insurance or any other similar type of personal injury insurance required by state or federal law, without regard to whether the Participant had such mandatory coverage. This Exclusion does not apply if the Injured person is a passenger in a non-family owned vehicle or pedestrian.

Postage, Shipping, Handling Charges, Etc.: That are for any postage, shipping or handling charges which may occur in the transmittal of information to the Third-Party Administrator, including interest or financing charges.

Prior to Coverage: That are rendered or received prior to or after any period of coverage hereunder, except as specifically provided herein.

Professional (and Semi-Professional) Athletics (Injury/Illness): That are in connection with any Injury or Illness arising out of or in the course of any employment for wage or profit; or related to professional or semi-professional athletics, including practice.

Prohibited by Law: That are to the extend that payment under this Plan is prohibited by law.

Provider Error: That are required as result of unreasonable Provider error.

Self-Inflicted: That are Incurred due to an intentionally self-inflicted Injury or Illness not definitively (a) resulting from being the victim of an act of domestic violence, or (b) resulting from a documented medical condition (including both physical and mental health conditions).

Subrogation, Reimbursement, and/orThird-Party Responsibility: That are for Illness, Injury or Sickness not payable by virtue of the Plan’s subrogation, reimbursement, and/or third-party responsibility provisions.

Unreasonable: That are not reasonable in nature or in charge (see definition of Maximum Allowable Charge) or are required to treat Illness or Injuries arising from and due to Provider’s error, wherein such Illness, Injury, infection or complication is not reasonably expected to occur. This Exclusion will apply to expenses directly or indirectly resulting from circumstances that, in the opinion of the Plan Administrator in its sole discretion, gave rise to the expense and are not generally foreseeable or expected amongst professional practicing the same or similar type(s) of medicine as the treating Provider whose error caused the loss(es).

Vehicle Accident: That are for treatment of any Injury where it is determined that a Participant was involved in a motorcycle Accident while not wearing a helmet or in an automobile Accident while not wearing a seatbelt (or car seat), even if the cause of the Illness or Injury is not related to the failure of the Participant to wear a helmet or seatbelt (or car seat). This Exclusion does not apply: (a) to Participants who were passengers on public transportation, ride for hire or livery services or (b) when a seatbelt or helmet is not required by law.

War/Riot: That Incurred as result of war or any act of war, whether declared or undeclared, or any act of aggression by any country, including rebellion or riot, when the Participant is a member of the armed forces of any country, or during service by a Participant in the armed forces of any country, or voluntary participation in a riot. This Exclusion does not apply to any Participant who is not a member of the armed forces and does not apply to victims of any act of war or aggression.

With respect to any Injury which is otherwise covered by the Plan, the Plan will not deny benefits otherwise provided for treatment of the Injury if the Injury results from being the victim of an act of domestic violence or documented medical condition. To the extent consistent with applicable law, this exception will not require this Plan to provide benefits other than those provided under the terms of the Plan.

Terms & Conditions

Healthcare Program

I understand that the Salvasen plan I am enrolling in includes a Limited Group Insurance Program, not comprehensive health insurance.

Billing and Renewal

Your Salvasen plan renews automatically by continuing payment of the monthly fees. There is no renewal fee. If a member wishes to change their billing cycle, they should contact Member Services at 1-877-707-1442.

Cancellation

Members may cancel their plan in writing during the first thirty (30) days from the date of the postmark on the member fulfillment package, plus five (5) days, and will receive a refund of monthly plan fees paid, including the one-time enrollment fee (if applicable). The cancellation effective date shall be the date of the postmark if sent by mail and the business day of receipt if sent by facsimile transmission. Members should allow three (3) to four (4) weeks for their refund. By submitting a claim during the first 30 days under any of the association group insurance plans, you acknowledge and agree that such a submission constitutes acceptance of the membership, the insurance benefits terms and conditions, limitations and exclusions. Submission of such a claim or use of any plan benefits constitutes a waiver of any and all refund rights. Members may cancel their plan at any time after the first thirty (30) days, provided Salvasen is given written notice of cancellation. Plan package and cards must be returned upon cancellation. It may take up to fourteen (14) to thirty (30) days after receipt of a valid cancellation request in order for charges, debits, or drafts to stop.

Membership Satisfaction

Your complete satisfaction is very important to us. If for any reason you are dissatisfied or have a complaint, please file your grievance by calling 1-877-707-1442 Monday through Thursday from 8 AM – 7 PM and Friday 8 AM – 5 PM, CST. You may also write us at: Member Services, PO Box 691247, Houston, TX 77269, or fax your dissatisfaction/complaint to 1-877-585-8842. You may also contact the appropriate regulating authority in your state.

Changes to Agreement

Salvasen reserves the right to change the terms & conditions of membership at any time given a thirty (30) day notice.

Contact Us

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(833) 915-0861