Non-Covered Waiver

Under your health plan, you are financially responsible for co-payments, co-insurance, and deductibles for covered services, as well as those services that exceed benefit limits. You are also financially responsible for all non-covered services as defined by your health plan contract. For example, this may include services such as flu vaccinations, EKG’s etc. The services or products may or may not be covered according to your health plan. Your acknowledgement below indicates that you have been advised of this information and that you agree to pay
for any services not covered under your plan.