Program Enrollment Agreements Terms and Conditions

The services that The Assistance Fund provides to individuals who have entered into Program Enrollment Agreements with The Assistance Fund are subject to the following Program Terms and Conditions, and such individuals must comply with these Program Terms and Conditions. Any personally identifying information provided to The Assistance Fund is subject to The Assistance Fund’s Privacy Policy, the terms of which are incorporated herein and available at https://tafcares.org/privacy-policy/ or upon request. The most current version of the Program Terms and Conditions can be reviewed by clicking on the “Program Terms and Conditions” hypertext link located at https://tafcares.org/agreements-terms-conditions/.

Program Terms and Conditions:

  • • All of the information provided by an individual must be truthful and accurate.
  • • Financial assistance provided by The Assistance Fund is to help insured individuals afford medications, health insurance premiums, other basic needs and/or incidental medical-related expenses.
  • • The Assistance Fund provides financial assistance to support an individual’s cost-sharing responsibilities, only.
  • • The Assistance Fund does not provide financial assistance (i) for medications that are not on an individual’s health plan’s formulary; (ii) in cases where the patient’s health plan determines the patient’s cost-share based on the amount a patient receives from other available patient assistance programs; or (iii) where The Assistance Fund is unable to verify the patient’s cost-share responsibility.
  • • If an individual’s health plan includes a maximum benefit amount that prevents payment from their health plan, claims after the maximum benefit is reached are not eligible for cost-sharing assistance.
  • • If an individual receives financial assistance related to genetic testing, the individual may not receive additional financial support unless diagnosed with a specific covered disease and can provide evidence of such diagnosis.
  • • The Assistance Fund does not provide assistance related to genetic testing of unborn children or genetic testing that is unrelated to a specific covered disease fund.
  • • Individuals are free at any time to switch healthcare providers, practitioners, pharmacies, insurers (unless the program an individual is enrolled in is restricted to Federal healthcare plans, only, in which case such individual cannot switch to an insurer that is not a Federal health care plan) or other healthcare suppliers without affecting their continued eligibility for financial assistance.
  • • An application for financial assistance does not guarantee funding is or will be available.
  • • Financial Assistance is always subject to the availability of funds.
  • • If an individual is approved for enrollment in a program, financial assistance is provided on a calendar year basis and all claims must be submitted by March 31st of the following calendar year (unless otherwise specified for the applicable program).
  • • Individuals must reapply for assistance each calendar year consistent with any enrollment periods set by The Assistance Fund.
  • • The Assistance Fund will only call or text the phone number provided in connection with an individual’s application or enrollment with The Assistance Fund or to solicit donations.
  • • If an individual elects to participate in a study conducted by The Assistance Fund, the terms of the Program Enrollment Agreement entered into by such individual shall apply to such study. Once enrolled in a study, any identifying information that an individual provides may be used by The Assistance Fund to analyze and evaluate The Assistance Fund’s programs, to determine trends in insurance reimbursement, patient therapy compliance and other statistics related to The Assistance Fund’s programs. Individuals may terminate their participation in a study at any time by contacting The Assistance Fund at help@tafcares.org or (855) 845-3663.
  • • Changes in an individual’s income, household size, need or any other relevant change, may impact an individual’s eligibility to participate in The Assistance Fund program(s).
  • • All provisions of assistance are based upon program rules and policies established by The Assistance Fund and not all applicants are eligible for participation.
  • • At any time during an individual’s enrollment in a program, they may be contacted to submit documentation to verify the information provided on their enrollment application.
  • • If an individual has not requested nor received assistance for a period of time designated by The Assistance Fund for the program they are enrolled in, The Assistance Fund reserves the right to remove them from participation in the program(s) and if their needs change in the future, they would need to reapply to the applicable The Assistance Fund program(s).
  • • If an individual begins receiving government benefits or any other subsidy and any portion of the benefits or subsidies are for retroactive financial assistance that The Assistance Fund already provided to the individual, the individual is responsible for reimbursing The Assistance Fund for the same amount of retroactive assistance that they received under this program.
  • • If an individual is enrolled in another charitable patient assistance program, they would not be eligible to receive financial assistance from The Assistance Fund.

Certifications and Acknowledgements:

  • • Any individual applying for a program certifies that they have been diagnosed with the disease state(s) covered by the program(s) they have applied for.
  • • Employees of The Assistance Fund that apply for or receive financial assistance from The Assistance Fund’s programs understand and acknowledge that other employees of The Assistance Fund will have access to such individual’s personal information, consistent with The Assistance Fund’s privacy policy.
  • • If an applicant is enrolling in a program (i) as an individual or (ii) on behalf of an individual as the parent or legal guardian of the individual under the age of eighteen (18), the applicant understands and acknowledge that The Assistance Fund contracts with a third-party vendor to verify the Income Information and Household Size provided in an individual’s enrollment application.
  • • If an applicant is enrolling in a program (i) as an individual or (ii) on behalf of an individual as the parent or legal guardian of the individual under the age of eighteen (18), the applicant hereby authorize The Assistance Fund to verify Income Information by obtaining, either directly or through a third-party vendor, a consumer credit report from a credit reporting agency, and understand that this soft inquiry or “soft pull” will not impact an individual’s credit score. Such inquiry may be visible to the individual when they view their credit report, but it will not be visible to other lenders or persons viewing their credit report for credit application purposes.
  • • Individuals entering into any program(s) consent to receive telephone calls and/or text messages, including those made with an automatic telephone dialing system and/or pre-recorded voice, at the phone number they provide.
  • • Individuals hereby warrant that the phone number provided is registered to them or they are otherwise an authorized user of the phone number.
  • • Participants hereby authorize The Assistance Fund to use de-identified study data as permitted by law.

Health Insurance Premium Assistance Programs

  • • If an individual is enrolled in The Assistance Fund’s health insurance premium assistance program, at the option of The Assistance Fund, funds will be paid directly to them as reimbursement for their payment to their insurance provider.
  • • The amount of assistance that an individual receives may only partially cover their insurance premiums, in which case the individual has the responsibility to pay the balance of such premiums in order to fulfill their financial obligation with their insurer.
  • • The Assistance Fund does not provide health insurance premium assistance for Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), or Health Reimbursement Accounts (HRA).
  • • A policy of insurance that is underwritten to cover an individual is their responsibility and such individual retains the responsibility to ensure that the related insurance premiums are paid in accordance with the insurance contract terms and conditions.
  • • Any individual enrolled in The Assistance Fund’s health insurance premium assistance program releases The Assistance Fund from liability and forever waive their right to make a claim against The Assistance Fund for the cancellation of, nonrenewal of, or denial of insurance (or any such application of insurance).
  • • It is an individual’s obligation to contact The Assistance Fund if they receive a notice of cancellation, non-renewal, or denial of insurance as such information may impact their ability to receive assistance from The Assistance Fund for such program(s).

Program Disbursements

  • • The Assistance Fund may provide financial assistance by means of various disbursement options that may include real time payments, ACH, check, Zelle, direct to debit card, PayPal, Venmo or another payment method administered by our service provider.
  • • Individuals may be required to provide The Assistance Fund or our service provider with certain personal information to process the financial assistance request disbursement.
  • • If an individual is entering into a Program Enrollment Agreement as the parent or legal guardian of an individual under the age of eighteen (18), the disbursement option will be issued in the parent or legal guardian’s name and they may be required to provide The Assistance Fund or our service provider with certain personal information to process the financial assistance disbursement.
  • • Out-of-pocket costs paid for by The Assistance Fund may not be submitted as claims for payment to any third-party payers, any other patient assistance foundations or accounts such as a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA).

Program Compliance:

  • • Individuals must comply with all applicable requirements, rules, policies and procedures of The Assistance Fund, including, but not limited to, taking medications for which an individual receives financial assistance from The Assistance Fund; and/or timely payment of health insurance premiums and the costs of basic needs and/or incidental medical-related expenses for which an individual receives financial assistance from The Assistance Fund.
  • • If an individual receiving assistance does not comply with The Assistance Fund’s rules, policies and procedures that apply to the program(s) enrolled in (which may change from time to time) or no longer requires financial assistance, the individual will be removed from participation in such program(s).
  • • If The Assistance Fund has discovered the information provided by an individual is not truthful or accurate, The Assistance Fund has the right to terminate the individual’s enrollment in a program and recover all amounts paid for claims submitted.
  • • The Assistance Fund is required to screen all applicants for compliance with its designated financial and other eligibility criteria prior to enrollment in its programs or within a reasonable time thereafter.
  • • If The Assistance Fund (or its third-party vendor) requests evidence to support an individual’s Income Information or Household Size, such individual must respond to The Assistance Fund (or its third-party vendor) and submit the requested information within the designated timeframe provided.
  • • If an individual fails to submit any documentation requested by The Assistance Fund within the designated timeframe, the individual may be removed from the program(s).
  • • If an individual who is receiving assistance from The Assistance Fund (i) has changes to their insurance benefit; (ii) no longer needs assistance; (iii) needs less assistance; (iv) has changes to their Income Information or Household Size, the individual must immediately notify The Assistance Fund of such change(s).
  • • The Assistance Fund will routinely review an individual’s ongoing requests for financial assistance.
  • • The Assistance Fund may conduct certain program audits and if an individual does not provide information that is requested of them, or otherwise engage in a pattern of uncooperative and/or disruptive behavior, they may be removed from a program. The Assistance Fund may determine, based upon the facts and circumstances and in its sole discretion, that such removal from a program is permanent.

The Assistance Fund reserves the right to pursue all available legal remedies in the event that any of the information that an individual provides to The Assistance Fund which is relied upon is false or an individual otherwise fails to comply with The Assistance Fund’s rules, policies or procedures.

Last Updated November 8, 2024