CONSENT TO CONDUCT BUSINESS ELECTRONICALLY
Please print or download a copy of this Consent for your records
We are required by law to obtain Your consent to deliver certain Communication(s) to You electronically. This Consent applies to all Communication(s) offered or accessible to You through electronic means, including, but not limited to, the Online Advantage website, or associated mobile applications. The words "We," "Us," and "Our" refer to the Company. The words "You" and "Your" mean You, the individual(s) insured or covered by a Contract, the entity to which a Contract is issued or provided, a Producer, or a Provider.
"Communication(s)" means all information that We are required to provide to You by law, or as reasonably necessary to administer or satisfy the terms of Your Contract, which includes, but is not limited to, Your enrollment or application form, declarations page, Policy, certificate, terms and conditions, claims adjudication, Explanation of Benefits, notices, correspondence, reports, billing statements, commission statements, and changes in the terms of Your Contract.
"Company" means one or more of the following companies: Union Security Insurance Company, Union Security Life Insurance Company of New York, Dental Health Alliance, L.L.C., affiliated prepaid/DHMO dental companies, and or any other current or future affiliated companies.
"Contract" means a Policy, a producer or enroller agreement, dental provider agreement, or any other contractual arrangement providing a product or service.
"Policy" means a written contract of insurance, or written agreement effecting insurance, or the certificate thereof, and includes all clauses, riders or endorsements, and declarations page.
"Producer" means an individual or entity appointed by the Company to engage in the solicitation, negotiation, sale, or servicing of a Contract pursuant to a producer or enroller agreement with Company.
"Provider" means a dentist or dental practice: (1) providing products or services to individuals insured or covered by a Company Contract; or (2) that have entered into a Contract to participate in a dental network operated by Company.
Scope of Communication(s) to Be Provided in Electronic Form. You agree that We may provide any Communication(s) in electronic format, and that We may discontinue sending paper Communication(s) to You. We reserve the right to modify the terms and conditions on which We provide electronic Communication(s) at any time.
Method of Providing Communication(s) to You in Electronic Form. All Communication(s) may be provided to You by one or more of the following methods, to the extent permissible by law: (1) via e-mail; (2) by access to a secure website ; (3) via text message (standard rates apply); or (4) other electronic means, as available.
How to Withdraw Consent. You may withdraw Your consent to receive Communication(s) electronically by calling Us at 800.733.7879; writing to Us at Assurant Employee Benefits, 2323 Grand Boulevard, Kansas City, MO 64108; or by e-mailing Us at email@example.com. Please allow a reasonable period of time to process Your request.
How to Update Your Records. It is Your responsibility to provide Us with true, accurate and up-to-date contact information, including, but not limited to, an email address. You can update Your information by calling Us at 800.733.7879; writing to Us at Assurant Employee Benefits, 2323 Grand Boulevard, Kansas City, MO 64108; or by e-mailing Us at firstname.lastname@example.org. Please do not send confidential information to Us via e-mail.
Hardware and Software Requirements. In order to access, view and retain electronic Communication(s) from Us, You must have: (i) an up-to-date device (e.g., computer, smart phone, tablet, etc.) suitable for connecting to the Internet; (ii) an up-to-date Internet browser; (iii) a valid e-mail account and software to access it; (iv) added the domain @assurant.com to Your e-mail account’s list of "safe senders;" (v) electronic storage capacity to retain Our Communication(s) and/or a printer; and (vi) software that enables You to view files in Portable Document Format. You may be able to download the most recent version of Adobe Reader by clicking here. If you cannot download the most recent version of Adobe Reader, please call your manufacturer to find out how to download software that is functionally equivalent.
Requesting Paper Copies. You may request a paper copy of any Communication by calling Us at 800.733.7879; writing to Us at Assurant Employee Benefits, 2323 Grand Boulevard, Kansas City, MO 64108; or by e-mailing Us at email@example.com. We may charge You a reasonable service fee for a paper copy.
Jurisdiction and Enforceability. You agree to submit to the exclusive jurisdiction of the United States District Court for the Western District of Missouri and the state courts located within Jackson County, Missouri to resolve any legal matter arising from this Consent. If any court of law, having the jurisdiction to decide on this matter, rules that any provision of this Consent is invalid, then that provision will be removed and the remaining provisions will continue to be valid and enforceable.
Acceptance and Consent. You acknowledge that: (i) you are authorized to receive this Consent; (ii) your consent to receive Communication(s) electronically does not expire and is not limited as to duration; (iii) the Company and its affiliates, subsidiaries and agents will not be liable for any loss, liability, cost, expense, or claim arising from the services provided pursuant to this Consent; and (iv) if You cannot access Your Communication(s), You must immediately notify Us so We can help identify the issue, or arrange to have the Communication(s) delivered via alternative means.
Form # EBC-BC-092313