Skip to main content

consent-to-electronic-payment

CONSENT TO ELECTRONIC TRANSACTIONS, PAYMENTS, AND SIGNATURE

  1. Consent to Electronic Transactions Throughout this “CONSENT TO ELECTRONIC TRANSACTIONS, PAYMENTS, AND SIGNATURE,” you will see the words "You,” "Your" and "Yours."  These refer to You as the holder of the credit card that entitles You to the benefits associated with the credit card.  Your claim will be reviewed and adjusted by ASURION SERVICES, LLC, a third party administrator, on behalf of Indemnity Insurance Company of North America, (“Chubb”) (collectively, “Us” and “We”).  By agreeing to the consent below, You acknowledge, agree and consent to the use by Us of electronic transactions, electronic signatures, and to the receipt of the electronic version of certain documents and records, including but not limited to acknowledgements, notices, forms, explanation of benefits, proof of loss, claims documentation, releases, authorizations to obtain medical records, affidavits, and/or disclosures, to the extent permitted by law.   You specifically acknowledge as part of Your consent that certain documents to be delivered electronically may contain confidential information and information regarding Your personal financial matters (“Personal Financial Information”) and other personally identifiable information, and consent to the delivery of such confidential information, Personal Financial Information and personally identifiable information by electronic means. The consent that You grant shall remain in effect until withdrawn by You.   You specifically acknowledge as part of Your consent that We will replace paper delivery of any particular document with electronic delivery at our sole discretion as electronic delivery of particular documents becomes available and You are consenting to delivery of documents to You in the following manner:   We may send You email transmissions of such documents, whether as text in, attachments to, and/or hyperlinks from such emails. Such emails will be sent to the current email address we have on file for You. You are responsible for providing Us with a valid email address to which You have regular access and You are responsible for immediately notifying us of any change of email address.  Notice of any change to Your email address can be provided by calling the toll free number listed in Your Guide to Benefits or can be sent via email to BSG@eclaimbenefits.com with the following subject line “CHANGE OF EMAIL”. The body of the email must include Your name, claim number, current email address (if available) and new email address in the body of the email.   You have the right to receive communications from Us in paper form.   At any time, You may withdraw this consent to provide You with records in electronic form. To withdraw Your consent, please call the toll free number listed in your Guide to Benefits or you can email us at BSG@eclaimbenefits.com with the following subject line “WITHDRAW ELECTRONIC CONSENT”. The body of the email must include Your name, claim number, and whether You want all Your claims communications to be in paper form. Your withdrawal will not affect or change in any way the legal effectiveness, validity or enforceability of any documents that were delivered to You electronically before Your withdrawal became effective.   To request a paper copy of any document that was originally provided to You electronically, at no charge, please call the toll free number listed in Your Guide to Benefits or You can email us at BSG@eclaimbenefits.com with the following subject line “DOCUMENT REPRINT”.  The body of the email must include Your name, claim number, and the particular notice or document You are requesting.  
  2. Consent to Electronic Payment   If any portion of Your claim is payable, in addition to receiving Your benefit payment via a paper check, We will also offer You the option to receive Your benefit payment as an electronic payment via automated clearing house (direct) deposit into Your checking or savings account, or payment via Debit Card (as available). We will not impose any fees on You for choosing to accept Your payment electronically, but Your financial institution may impose a fee or charge.  By consenting  below, You are consenting to accept Your benefit payment for this claim electronically should  You subsequently choose to receive Your benefit payment electronically.  You may submit Your claim electronically, yet still select the option to receive Your benefit payment via paper check mailed to the address on file.   If Your claim is payable, You will receive an email from Us notifying You that Your claim has been approved for payment.  You will be asked at that time to confirm Your preferred payment delivery method after clicking the hyperlink provided in that email.  If You do not respond to this email within 48 hours from the date it was sent to You, a paper check will be sent to the address we have on file.    Unclaimed funds are subject to the applicable laws concerning unclaimed property.    
  3. Consent to Electronic Signature You also agree that Your electronic signature is the legal equivalent of Your manual signature on this document and on the above-listed documents. You further agree that Your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise agree, acknowledge, consent, opt-in, or certify to this consent and any of the above-listed documents constitutes Your signature, acceptance and agreement as if manually signed by You in writing. You agree that no certification authority or other third-party verification is necessary to validate such signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of such signature or any such document. You represent that You will be bound by the terms of this consent. This consent for electronic delivery and signature is effective until withdrawn by You. Doing business electronically will not affect the validity, legal effect or enforceability of any of Your transactions with Us.   You are responsible for ensuring that neither Your software nor Your Internet Service Provider inhibits or interferes with the notices and communications described herein. To ensure delivery of Your claim forms and/or other documents, the following minimum hardware and system requirements are necessary to sign, print, retain and receive such documents.   Operating Systems Windows® 10 or 11 or MAC Browsers Final release versions of Microsoft Edge 95 or above (Windows and Mac); Mozilla Firefox 34 or above (Windows and Mac); Safari™ 12.0 or above (Mac only); Google Chrome 95 or above (Windows and Mac) ; Apple iOS 12 or above; Android 10 and above PDF Reader Acrobat Reader® or similar software may be required to view and print PDF files Screen Resolution 800 x 600 minimum Enabled Security Settings Allow per session cookies   By consenting below, You are confirming that Your computer or electronic device meets the system requirements necessary to print, store and receive claims documents electronically and that You may be able to access such documents for future reference.