1. General Terms
1.2. The right to use this Site is personal to you and is not transferable to any other person or entity. You are responsible for protecting the confidentiality of your password and user name, if you have them. You may only use this Site to access information about you or your dependents. Do not use this Site to access information about any other person, including a friend or family member.
1.3. You acknowledge that this Site may experience service interruptions or events that are beyond Company’s control and that Company will not be responsible for any information you may lose while you are using this Site or when you transmit information to this Site via the Internet.
1.4. Your use of the Internet and this Site is solely at your own risk. You may not share your login name, password or other credentials with a third party. You agree to assume all risks associated with any usage, whether or not authorized, of your login name, password or other credentials or other information you share with or have access to on this Site and further release us from any and all claims, liabilities and damages, of whatever nature, related to this Site.
1.5. You represent and warrant to us that you are age 18 or older. Use by those under the age of 18 is not authorized. This Site is not directed at children under the age of 13. Company does not knowingly permit registration or submission of personally identifiable information by anyone younger than 13 years of age.
2. Information on the Site
2.1. Company has no legal duty to you to update information on this Site. This means information on this Site may be out of date at any given time. Company also may make improvements or changes to the information, products, or services described on this Site at any given time without notice.
2.2. Company has no legal duty to you to update information on this Site. This means information on this Site may be out of date at any given time. Company also may make improvements or changes to the information, products, or services described on this Site at any given time without notice.
2.3. We may modify, remove, or update information on this Site without notice. Company may change or terminate any feature of this Site, including, but not limited to, content, hours of availability, and equipment needed for access or use. Company may stop providing any information or category of information, may change or eliminate any transmission method, and may change transmission speeds or other aspects of this Site’s operation. If we terminate your access to this Site, then this Agreement shall remain in full force and effect and shall survive as the governing terms of your access and use of the Site and Services prior to your termination. Furthermore, we may modify or discontinue your access to any or all of this Site in our discretion at any time.
2.4. Depending on your status, you may have access to eligibility and benefits information through this Site. The information you obtain is not a guarantee of payment. Unless otherwise required by state law, any information you obtain regarding eligibility and benefits is not a guarantee of payment. Benefits are subject to all contract limits and member status on the date of service and other terms of your insurance policy or benefit plan. Also, nonpayment of premiums and other contractual limitations may result in denial of benefits or refunds. You should always consult your insurance policy or benefit plan document about what your insurance policy or benefit plan covers.
Accumulated amounts such as deductibles may change as additional claims are processed. Deductible and out-of-pocket limits may not apply for all services under your benefit plan. The deductible and out-of-pocket status information is a standard calculation based on the limits for professional outpatient services performed in a hospital. If your benefit plan does not impose a limit for this service or includes different limits for other types of services, the actual amounts may vary.
The replacement deductible is for the deductible specific to the service type requested. This replaces the global deductible for this service type. Please contact Customer Service for additional information regarding benefits.
2.5. Nothing contained, expressed, or implied in this Site is intended as, nor shall be construed or understood as, medical advice. No doctor-patient or other medical provider-patient relationship is established between Company and you by reason of your use of this Site or under any circumstances whatsoever. The information in this Site is for general informational purposes only. If you have questions about medical issues or health information arising from your use of this Site, you should contact your own health professional.
2.6. Nothing contained, expressed, or implied in this Site is intended as, nor shall be construed or understood as, legal or financial advice, guidance, or interpretation. No attorney-client or accountant-client relationship is established between Company and you by reason of your use of this Site or under any circumstances whatever. The information in this Site is for general informational purposes only. If you have questions about any law, statute, regulation or requirement expressly or implicitly referenced in this Site, or its financial ramifications, you should contact your own legal counsel, financial professional, or both.
Confidentiality of Communications: Communications that you post to this Site are not confidential. You are responsible for your own communications and the consequences of such posting. Some parts of this Site may allow you to post, or to e-mail to Company, materials or information ("Visitor Content"). Communications that you post to this Site are not confidential. You are responsible for your own communications and the consequences of such posting. You grant Company the unrestricted right to use or distribute, free of charge, any Visitor Content posted on this Site by you or anyone using your login information. COMPANY DOES NOT REPRESENT OR GUARANTEE THE TRUTHFULNESS, ACCURACY OR RELIABILITY OF ANY COMMUNICATIONS POSTED BY OTHER USERS OR ENDORSE ANY OPINIONS EXPRESSED BY OTHER USERS. ANY RELIANCE ON MATERIAL POSTED BY OTHERS IS AT YOUR OWN RISK. Company may review, remove or edit any Visitor Content at its discretion. COMPANY HAS NO RESPONSIBILITY AND ASSUMES NO LIABILITY FOR VISITOR CONTENT POSTED BY YOU OR BY ANY OTHER PARTY.
3. Proprietary Rights
3.1. This Site and all contents posted on this Site are the exclusive property of Company or are licensed to Company for its use. Company is the owner or licensee of the copyright in the entire content (including images, text, and look and feel attributes) of this Site and reserves all rights in that regard. YOU MAY NOT POST, LINK, OR MAKE OTHER MODIFICATIONS TO THIS SITE OR COPY MATERIAL FROM THIS SITE WITHOUT COMPANY’S EXPRESS WRITTEN CONSENT.
3.2. Company does not transfer or grant any of its intellectual property or other rights to you, including any copyright, trademark, service mark or patent rights, all of which Company expressly reserves for itself. You may not remove or change any copyright notice on any material on this Site.
3.3. (a) If you are an individual member, participant, or beneficiary, you may make reasonable use of this Site and content on this Site for your personal or household purposes. If you are an individual who is participating in a wellness program administered in whole or in part by Company (“Wellness Program”), but are not otherwise a member, participant, or beneficiary of a policy or group health plan administered in whole or in part by Company, you may use the Site solely to participate in the Wellness Program. Regardless of the purposes for which the above language permits you to use this Site, you may not use content on this Site for any commercial purpose. Also, you agree not to distribute, manipulate, create derivative works from, or use the information on this Site for any purpose other than as described above or as expressly authorized by Company. You additionally acknowledge that you do not acquire any ownership rights by copying or downloading copyrighted material.
(b) If you are a health care provider who has patients who are entitled to health benefits through insurance provided by or any other health benefit plan administered by Company, you may use the provider designated portions of this site solely to the extent minimally necessary for your internal business purposes of managing payment by Company or its clients of claims for services covered by said plan and that are rendered by you to said patients. You agree that this permission may not be sub-licensed or otherwise granted to any third party. Furthermore, you agree not to distribute, manipulate, create derivative works from, or use the information on this Site other than as described above or as expressly authorized by Company in a writing signed by an officer of Company authorized to bind Company in the matter. You acknowledge that you do not acquire any ownership rights by copying or downloading copyrighted material.
(c) If you are a group health plan client or plan sponsor of such a plan administered or insured by Company, you may use the Permitted Portions of this Site to the extent minimally necessary for the plan’s healthcare operations or payment purposes only regarding members, participants or other beneficiaries that are insured or administered by Company only. The Permitted Portions of this Site shall be defined to be those portions of this Site designated as for group health plan clients or plan sponsors only. You agree that this permission may not be sub-licensed or otherwise granted to any third party. You agree not to distribute, manipulate, create derivative works from, or use the information on this Site for any purpose other than as described above or as expressly authorized by Company in a writing signed by an officer of Company authorized to bind Company in the matter. You acknowledge that you do not acquire any ownership rights by copying or downloading copyrighted material.
(d) Any usage by third parties other than as described in Section 3.3 (a), (b), or (c) above is prohibited.
(e) You agree that you shall comply with all applicable laws, regulations or other government directives regarding your use. You agree that you do not have permission to use and will not use this Site: (i) to access any information for which you do not have the legal right to view; or (ii) to distribute or publish any defamatory statements, pornographic material, copyrighted, trademarked or other proprietary material. You may not submit or post any material or information which is illegal, obscene, threatening, defamatory, invasive of privacy, or infringing of proprietary rights of any person or entity, or which contains software viruses, corrupted data, cancel bots, commercial solicitations, or mass mailings or any form of "spam." You may not use a false e-mail address to impersonate any person or otherwise mislead as to the origin of any material or information you submit or post.
3.4. Any violation of this Agreement may result in copyright, trademark, or other intellectual property right infringement that may subject you to civil and/or criminal penalties. This Site contains Company’s copyrighted material, trademarks, and other proprietary information, including, but not limited to, text, software, photos, video, graphics, music, and sound. This content is protected by copyright as a collective work under the United States copyright laws.
4. Security/Privacy; Other Websites; Information Sharing; Mobile Device Information Usage; Consent to Usage of Information; Email Usage; Cookies and Similar Technologies
4.1. Security/Privacy. This Site has security/privacy measures in place to protect against the loss, misuse and alteration of the information under our control. While your Username and Password are used to initially recognize you as an enrolled member, some of the functions offered by this Site may require a higher level of validation and will use your member/group/provider/agent number and date of birth to allow access to these functions. We may also require multi-factor authentication and may send you a code via voice, text, or email (as chosen by you) that you will have to use to access the Site. We use your Internet Protocol (IP) address to help diagnose problems with our server, and to administer this Site. Your IP address is also used to help identify you and to help gather broad demographic information. Although we have security and privacy measures in place, we cannot guarantee that unauthorized third parties (including computer hackers) will not gain unauthorized access to your information or otherwise misuse the system. Use your own best judgment when sending information via the Internet to an email address or website or this Site. Email sent via the Internet may pass through private and public networks with varying levels of security. Some networks may have taken steps to secure email transmissions while others have not, thereby compromising the privacy and integrity of an email. An email may be copied, altered or destroyed.
4.2. Third Party Sites, Terms and Information Sharing. As you navigate through this Site, you will be able to link to other sites for special offers or information. Please note that we provide these links for your convenience, but inclusion of the link does not imply endorsement by us. We do not guarantee any third party’s performance and do not guarantee any of the services or materials provided by any third party. The linked sites are not under our control and we are not responsible for the contents of any linked site or any link contained as a linked site. You may be required to accept a linked website’s separate terms and conditions in order to access such website. Some linked sites may provide particular, personalized services. For the linked site to provide this type of detailed information, it may be necessary for us to provide the linked site with specific information related to your personal information. Your acceptance of this Agreement constitutes your agreement that we may provide such linked sites with necessary personal information. Because we do not control the linked sites, we encourage you to understand the privacy policies of linked sites. Obviously, we cannot be responsible for the privacy practices or the content of such websites. With regard to third party information, we do not endorse or otherwise recommend or approve any product or information located on or available through this Site.
4.3. Mobile Device Usage and Information. You agree to the following:
(a) Mobile usage includes any program or service accessed or used via your mobile device (e.g. a portable computer, iPad, iPhone, smart phone, smart watch, smart pad, or other such device) and the software modules operating within our mobile environment and appearing on your mobile device that provide you access to a variety of content and services.
(b) We collect information for mobile usage, such as your device type and hardware IDs; the request type; your mobile carrier; your mobile carrier’s user ID; the content of your request; basic usage stats about your device; and use of our products and services. This information does not by itself identify you to us, though it may be unique or consist of or contain information that you consider personal. If you use location-enabled products and services, such as Google Maps for mobile, you may be sending us location information. This information may reveal your actual location, such as GPS data, or it may not, such as when you submit a partial address to look at a map of the area.
Certain use of our products and services allows you to download and/or personalize the content you receive from us. For these products and services, we will record information about your downloads and preferences, along with any information you provide about yourself. If the product or service requires you to log in with a specific account, this information will be associated with your account.
(c) All requests made via your mobile device must be sent through your mobile carrier's network and your mobile carrier may have access to it. For information regarding your mobile carrier's treatment of your information, please consult your mobile carrier's privacy policies.
4.5. Consent to use of Email. You agree Company may use any email address you supply to correspond with you regarding this Site, to provide any services, products, or benefits to you, your spouse or your dependents and to send other communications, including, without limitation, marketing communications, to you, your spouse or your dependents. Company also may retain this email address for such future use as Company may determine. Additionally, Company may send email responses to questions submitted to Company. If you would like to update your personal information, you may do so either via the Site customer services functions or by calling the Customer Service department. If you are an individual member, participant, or beneficiary, to opt-out of receiving email communications or otherwise manage your contact information and/or preferences, please log into the Site, click on My Profile, then click on My Contact Information and My Contact Preferences. If you are a health care provider, to opt-out of receiving email communications or otherwise manage your contact information and/or preferences, please contact us at 800-768-4375. If you are a health plan client or plan sponsor, to opt-out of receiving email communications or otherwise manage your contact information and/or preferences, please contact your PAI account representative.
4.6. Consent to Delivery of Notices or Documents by Electronic Means. In addition to Sections 4.4 and 4.5 above, but subject to the limitations and rights below, by supplying your contact information electronically, you affirmatively consent to the delivery of notices or other documents electronically. PLEASE TAKE NOTICE OF THE FOLLOWING LIMITATIONS AND RIGHTS:
(A) YOU HAVE A RIGHT TO RECEIVE NOTICES OR OTHER DOCUMENTS DELIVERED TO YOU IN A PAPER OR OTHER NON-ELECTRONIC FORM AT NO ADDITIONAL COST;
(B) IF YOU HAVE CONSENTED TO THE RECEIPT OF NOTICES OR OTHER DOCUMENTS BY ELECTRONIC MEANS, THEN YOU MAY WITHDRAW THAT CONSENT AT ANY TIME AS INDICATED IN SECTION 4.5 ABOVE OR SUBSECTION (E) BELOW;
(C) THE NOTICES OR OTHER DOCUMENTS COVERED BY THIS CONSENT INCLUDE, WITHOUT LIMITATION, THE FOLLOWING: ENROLLMENT DOCUMENTS, EXPLANATIONS OF BENEFITS, NOTICES OF CANCELLATION OR TERMINATION OF BENEFITS OR COVERAGE, GRANTS OR DENIALS OF CLAIMS, COMMUNICATIONS RELATED TO THE FILING AND PAYMENT OF CLAIMS OR TO PLAN OR OTHER CONTRACTUAL LIMITATIONS, WELLNESS PROGRAM DOCUMENTS, DISEASE MANAGEMENT PROGRAM DOCUMENTS, OR ANY OTHER DOCUMENTS OR NOTICES RELATED IN ANY WAY TO YOUR RELATIONSHIP WITH COMPANY OR YOUR HEALTH BENEFIT OR OTHER INSURANCE OR BENEFIT PLAN;
(D) IF YOU ARE AN INDIVIDUAL MEMBER, PARTICIPANT, OR BENEFICIARY, TO OBTAIN, AT NO ADDITIONAL COST, A PAPER COPY OF ANY NOTICE OR DOCUMENT DELIVERED TO YOU ELECTRONICALLY, PLEASE CONTACT THE CUSTOMER SERVICE NUMBER ON THE BACK OF YOUR CARD. OTHERWISE, TO OBTAIN SUCH PAPER COPIES, IF YOU ARE A HEALTH CARE PROVIDER, PLEASE CONTACT US AT 800-768-4375, OR IF YOU ARE A HEALTH PLAN CLIENT OR PLAN SPONSOR, PLEASE CONTACT YOUR PAI ACCOUNT REPRESNETATIVE;
(E) IF YOU ARE AN INDIVIDUAL MEMBER, PARTICIPANT, OR BENEFICIARY, TO WITHDRAW YOUR CONSENT TO ELECTRONIC RECEIPT OF NOTICES AND DOCUMENTS, PLEASE LOG IN TO THE SITE AND GO TO MY PROFILE, THEN MY CONTACT PREFERENCES TO SWITCH FROM ELECTRONIC DELIVERY TO MAIL. OTHERWISE, TO WITHDRAW YOUR CONSENT, IF YOU ARE A HEALTH CARE PROVIDER PLEASE CONTACT US AT 800-768-4375, OR IF YOU ARE A HEALTH PLAN CLIENT OR PLAN SPONSOR, PLEASE CONTACT YOUR PAI ACCOUNT REPRESENTATIVE; AND
(F) IF YOU ARE AN INDIVIDUAL MEMBER, PARTICIPANT, OR BENEFICIARY, TO UPDATE YOUR CONTACT INFORMATION FOR THE PROVISION OF ELECTRONIC NOTICES AND DOCUMENTS, PLEASE LOG IN TO THE SITE AND GO TO MY PROFILE, THEN MY CONTACT INFORMATION. OTHERWISE, TO UPDATE YOUR CONTACT INFORMATION, IF YOU ARE A HEALTH CARE PROVIDER PLEASE CONTACT US AT 800-768-4375, OR IF YOU ARE A HEALTH PLAN CLIENT OR PLAN SPONSOR, PLEASE CONTACT YOUR PAI ACCOUNT REPRESENTATIVE.
(G) FOR A LIST OF HARDWARE AND SOFTWARE REQUIREMENTS NECESSARY FOR ACCESSING AND RETAINING THESE ELECTRONIC NOTICES OR DOCUMENTS, PLEASE CONTACT US AT 800-768-4375. PLEASE NOTE THAT THESE REQUIREMENTS MAY CHANGE AND THAT YOU ARE RESPONSIBLE FOR MONITORING THEM FOR ANY CHANGES.
4.8. Consent to Monitoring or Recording. Through your usage of or interaction with this Site, you, to the maximum extent permitted by applicable law, (i) consent to Company (or any vendor or subvendor of Company) monitoring and recording any such usage or interaction, and any devices used directly or indirectly to achieve such interaction; and (ii) agree that this monitoring or recording may be used for security, customer service, training, or other business purposes.
5. Limitation of Liability; Warranties
5.1. By using this Site, any programs or tools on the Site, and any third-party sites to which you may link through this Site you agree to (a) release Company from any and all claims, liabilities or damages related to such use and (b) accept all risks related to such use.
5.2. You agree not to hold Company responsible for any damages or injury, whether for breach of contract, tortious behavior, negligence, or under any other cause of action, caused by any failure of performance, error, omission, interruption, deletion, defect, delay in operation or transmission, computer virus, communication line failure, theft or destruction, or unauthorized access to, alteration of, or use of records or information made available on (a) this Site, (b) any program or other tool available at this Site, or (c) any third-party site to which you may link through this Site. Without limiting the foregoing, you specifically agree not to hold Company responsible for the defamatory, offensive, or illegal conduct of any third party using this Site.
5.3. ALL MATERIALS ON THIS SITE ARE PROVIDED AS IS, WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED. COMPANY DISCLAIMS ANY AND ALL EXPRESS AND IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.
5.4. COMPANY SHALL NOT BE LIABLE FOR ANY SPECIAL, INDIRECT, PUNITIVE, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, LOST REVENUES OR LOST PROFITS, THAT MAY RESULT FROM THE USE OF THIS SITE, THE MATERIALS POSTED ON THIS SITE, AND LINKS PROVIDED ON THIS SITE.
5.6. This Site is controlled and operated by the Company from offices in the United States. Company makes no representation that materials provided on this Site are appropriate or available for use in other locations and access to them from locations in which their contents are illegal is prohibited. Those who choose to access this Site from such other locations are responsible for compliance with applicable local laws.
6.2. You agree that any cause of action arising out of or related to this Site or your use of this Site must commence within one (1) year after the cause of action accrues. Otherwise, such cause of action is permanently barred.
6.4. By using this Site, you agree that any claim, suit or dispute resolution proceeding will be conducted only on an individual basis and not in a class or representative action.
7.1. Electronic Signature and Agreement. You agree to conduct business through and electronic signature and electronic agreement and that the act of clicking the words “Continue” or “Yes” or “I agree” or any similar phrasing anywhere in using this Site is intended by both parties to be an electronic signature that has the same significance as a signature in ink and that both such signature and this Agreement are considered to be in writing to the maximum extent permitted by law.
7.3. You agree that, if you experience any problems in using this Site or need to request assistance in using this Site, you should contact the following: 800-768-4375.
7.4. This Agreement does not establish any relationship or partnership, joint venture, employment, franchise or agency between you and us.
7.5. If any provision of this Agreement is determined to be invalid or unenforceable, then all other provisions of this Agreement shall remain in full force and effect. If any provision of this Agreement is determined to be invalid or unenforceable, then the court shall enforce this Agreement to the maximum extent allowed by law or equity.
Revised: May 28, 2020