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STEP 1/2

Do you have commercial prescription drug insurance?

If you are enrolled in Medicare, Medicaid, or any other federal, state, or government-funded healthcare program, select "No".

Have you read, and do you accept and agree to comply with, At Your Service Program Terms, Conditions, and Eligibility Criteria?

By activating this At Your Service Savings Offer, you certify that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this savings program.

STEP 2/2