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. 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/.
Compliance: If accepted into programs offered by The Assistance Fund, financial assistance provided is to help insured individuals afford medications, health insurance premiums, other basic needs and/or incidental medical-related expenses. Therefore, 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. In the event that 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 an individual no longer requires financial assistance as evidenced by lack of requests for and receipt of assistance, then the individual will be removed from participation in such program(s). An individual is not eligible for costsharing assistance from The Assistance Fund if an individual or an individual’s health plan participates in any program which restricts in any way their insurance benefits or coverage contingent upon such individual’s acceptance into one of The Assistance Fund’s programs or shifts reimbursement for a particular drug from their health plan to The Assistance Fund. The Assistance Fund does not provide financial assistance to individuals that do not have insurance that covers the individual’s medications that they are seeking financial assistance for. The Assistance Fund does not provide financial assistance for medications that are not on an individual’s health plan’s formulary or are deemed by an individual’s health plan to be a non-essential health benefit. The Assistance Fund provides financial assistance to support patient cost-sharing responsibilities, only. If an individual’s health plan includes a maximum benefit amount that limits payment from their health plan, drug claims after the maximum benefit is reached may not be eligible for financial 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 state 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 state 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 a insurer that is not a Federal health care plan) or other healthcare suppliers without affecting their continued eligibility for assistance. Application for assistance does not guarantee funding is or will be available. If an individual is approved for participation in a program, such financial assistance is provided on a calendar year basis and all claims must be submitted by March 31 of the following calendar year (unless otherwise specified for the applicable program). Thereafter, individuals must reapply for assistance each calendar year. Assistance in any year is always subject to the availability of funds and there is no guarantee such funds will be available.
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. The Assistance Fund will only call or text the number provided in connection with an individual’s application or enrollment with The Assistance Fund or to solicit donations. Individuals hereby warrant that the phone number provided is registered to them or they are otherwise an authorized user of the phone number.
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. Participants hereby authorize The Assistance Fund to use de-identified study data as permitted by law. Individuals may terminate their participation in a study at any time by contacting The Assistance Fund at email@example.com or (855) 845-3663.
The Assistance Fund may provide financial assistance by issuing an individual a debit card that is funded pursuant to The Assistance Fund’s policies and procedures. If an individual is entering into a Program Enrollment Agreement as the parent or legal guardian of a patient under the age of eighteen (18), the debit card may be issued in their name and they will be required to provide The Assistance Fund with certain personal information (such as date of birth and social security number), in addition to the minor patient’s information, to receive financial assistance in this manner.
Change in Insurance, Household Income/Household Size, or Other Information Provided in this Application: At any time that an individual is receiving assistance from The Assistance Fund, if their insurance benefit changes, if they are no longer in need of assistance, in need of less assistance, or their Income Information or Household Size changes, they will immediately notify The Assistance Fund and provide such change(s). Changes may impact their participation in The Assistance Fund program(s), including a reduction in the amount of assistance provided or a termination of assistance entirely. All provisions of assistance are based upon program rules and policies established by The Assistance Fund and not all applicants are eligible for participation.
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. In the event that 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).
Furthermore, 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 such individual, they are responsible for reimbursing The Assistance Fund for the same amount of retroactive assistance that they received under this program. 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).
Waiver and Release of Liability: 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. If the assistance only partially covers an individual’s insurance premiums, they have the responsibility to pay the balance of such premiums in order to fulfill their financial obligation with their insurer. 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, non-renewal 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). 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 January 25, 2024