NOTICE TO INDIVIDUAL : Coverage will be effective the date the correct premium is received by the company or a representative of the Company or the effective date of the coverage period,whichever is later,unless otherwise stated in the Schedule of Benefits. By signing the individual acknowledges the following: 1) He/She has carefully read the Summary of Benefits and elects to enroll as indicated on this enrollment card; 2) He/She meets the eligibility requirements for this coverage as described in the brochure; 3) Upon enrollment we require the 1st and month's premium; and 4) Acknowledge this plan does not provide comprehensive major medical services. Cancellations must be submitted at least 5 days prior to the recurring ACH billing date. PREMIUM WILL NOT BE REFUNDED EXCEPT FOR INELIGIBILITY OR ENTRANCE INTO THE ARMED FORCES.