Terms and Conditions
I hereby apply for membership enrollment in the Rx101 Prescription Drug Program. In understand that acceptance of this application of membership is guaranteed and that the following effective dates apply:
              1st of the month effective date: application received by the 10th of the prior month
              15th of the month effective date: application received by the 25th of the prior month
I understand that by participating in this program, external factors may force a change in monthly fee, benefits or preferred drug list at any time. I will be entitled to negotiated and funded discounts on eligible prescription drugs purchased from any participating pharmacy.

Medical Information
Rx101 designated pharmacy benefit administrator may use, without consent, de-identified information solely for purposes for billing pharmaceutical manufacturers who participate in this program to help reduce your cost. This information does not contain any personal information which might be used to identify you.

Return Policy
YourRx101 membership may be cancelled at any time. Your enrollment fee is not refundable.

If paying on a monthly basis, your cancellation must be received in our offices five (5) days prior to your next draft:
             Draft date of the 25th: cancellation received by 20th of the month
             Draft date of the 10th: cancellation received by the 5th of the month
If paying on a yearly basis, you will be refunded for the prorated portion of your unused membership. A cancellation must be received in our offices five (5) days prior to your effective day of eligibility in order to refund the next month’s prorated fees:
            Group number is HCG101 or 301: cancellation must be received by the 25th of the month
            Group number is HCG115 or 315: cancellation must be received by the 10th of the month

All refunds will be paid by check, regardless of the original payment method chosen by the member. All refunds will be mailed within two weeks of the cancellation date.

Additional Questions
If you still have additional questions on this or any other information, please call our offices at 877-377-9101. Our member services representative is available Monday through Friday from 9 a.m. to 4 p.m. Eastern Standard Time.