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Terms and Conditions/User Agreement for Ametros CareGuard

Effective Date: 8-1-2016

This agreement (the “agreement”) between Ametros Financial Corporation (“CareGuard”) located at P.O. Box 827, Burlington, MA 01803 and the “member” identified via the user profile created by said member and signed member agreement. CareGuard and members are collectively referred to herein as the “Parties” and each as a “Party”.

Whereas, the purpose of this agreement is to establish a custodial account and relationship where CareGuard provides professional support services in connection with the Medicare Set-Aside established for the member upon the terms and conditions in this agreement. Said agreement, will also provide the member with access to CareGuard’s online transaction and financial management member portal.

Rights and Responsibilities of CareGuard
CareGuard agrees to act as an advocate of member solely with respect to the proper disbursement and accounting of expenses from the account according to the Professional Administration MSA requirements. Notwithstanding anything to the contrary contained in this Agreement, CareGuard’s sole duties and responsibilities to Member are limited to the following:
• Place funds in an interest bearing account
• Make authorized and related payments from the account on Member’s behalf in accordance with the right payment fee and reimbursable rates
• To use reasonable efforts to secure discounts on medical treatment on Member’s behalf
• Keep accurate records of the disbursement and additions to the account and report those to Member. Transactions will also be made available via the online user portal.

Member acknowledges and agrees that (i) Member will receive the benefit of negotiated volume discounts, (ii) CareGuard may, from time to time, receive discounts and/or placement fees from Third Parties including, but not limited to the Bank or one or more pharmacy benefit managers in connections with the services that it provides; and (iii)that there can be instances in which all of such discounts and or fees may not be passed on to Member. However, it being understood that any discounted pricing secured directly for the member’s purchase shall be passed on to the Member.

Rights and Responsibilities of Member
Member represents and agrees that:
• Member will provide MSA or medical settlement funds to CareGuard
• Member is responsible for any taxes, interest, and other expenses which may be payable under law in connection with the account
• To provide CareGuard with any necessary information that CareGuard may need to prepare reports and pay medical necessary and related medical bills
• To forward any related and covered out of pocket expenses for reimbursement. Said expenses can be uploaded directly for processing, via the online member portal.
• To report any discrepancy in the monthly Member Statement within (60) days of the issuance date.

CareGuard Disclaimers
Notwithstanding anything to the contrary contained in this agreement, CareGuard shall not be held responsible or liable for any of the following.
• Member’s use of or reliance on any materials, documentation and/or any communication (whether written, oral or in electronic form) from CareGuard to Member under this agreement or otherwise that member construes or relies upon as legal, tax or other professional advice. CareGuard assumes no responsibility for tax or other consequences to anyone arising from the establishment, use or administration of the MSA
• Member hereby acknowledges and agrees that no Third Party or any other entity, signatory or other person acting on Member’s behalf (including, but not limited to Member), shall have any remedy against CareGuard for improper disbursement made by CareGuard from the account other than as permitted under the MSA regulations, which limits liability to the repayment of the account in an amount not to exceed the amount of the improper disbursement.
• CareGuard will not be liable for any of Member’s pre-existing payments or mismanagement of the MSA funds. CareGuard is only liable for accounting on items with a date of service after the date of the executed member agreement.

Other Terms, Conditions and Notices
• Amendments – CareGuard may amend this agreement at any time for changes required by law or required by the MSA regulations.
• The CareGuard online user portal, is an web based application, which provides the member with insight into their account history, financial transactions, spend trending, claims, ect. The user portal also allows includes the functionality to update member information, and add providers.

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