Plan Cost Information

Plan I
  Monthly Annual* Annual Discount
Individual $33.26 $399.12 $0.00
Individual +1 $63.86 $766.32 $0.00
Family $109.43 $1,313.16 $0.00

One Time Non-Refundable Processing Fee:

Monthly: $0.00

Annual: $0.00

Note: For primary applicants age 55 years and older plus their eligible dependents coverage is offered at an increased rate. Final rate will be calculated when completing your application.

Delta Payment Options
Credit Cards Accepted: Visa, MasterCard, American Express and Discover
Initial Payment Options Ongoing Payment Options
Monthly Credit Card Monthly Credit Card
Annual Credit Card Annual Credit Card
Monthly E-Check Monthly E-Check
Annual E-Check Annual E-Check
Your payment will be processed as follows
Credit Cards Accepted: Visa, MasterCard, American Express and Discover
Initial Payment Options
Monthly Credit Card Application processed within 5 business days and credit card charged on the 5th business day from your requested effective date
Annual Credit Card Application processed within 5 business days and credit card charged on the 5th business day from your requested effective date
Monthly E-Check Application processed within 5 business days and e-check (ACH) drafted on the 5th business day from your requested effective date
Annual E-Check Application processed within 5 business days and e-check (ACH) drafted on the 5th business day from your requested effective date
Ongoing Payment Options
Monthly Credit Card Processed on the 5th business day of each month
Annual Credit Card Processed each year on the 5th business day from your next effective date
Monthly E-Check Processed on the 5th business day of each month
Annual E-Check Processed each year on the 5th business day from your next effective date

Cancellations

If you are not satisfied, you may return the Policy within 10 days after you received it. Mail or deliver it to P.O. Box 1596, Indianapolis, IN 46206. Any premium paid will be refunded (less enrollment fee which is not refundable). This Policy will then be void from its start.

You may return the Policy after the first 10 days following receipt by giving written notice to us effective upon receipt or on a later date as may be specified in the notice. We shall promptly refund the excess of paid premium above the pro rata premium for the expired time. Cancellation is without prejudice to any claim originating prior to the effective date of cancellation.

Free American Senior Benefits Association Membership:
If you are age 55 and older membership in the American Senior Benefits Association is required, at no additional cost, in order to be eligible for insurance coverage. The Association is a membership organization for seniors that provides educational information and discounts on goods and services to its members. The Association benefits information will be sent under separate cover. I understand while covered by this product that I must at all times be a member of the Association.